E
ents
STAPL
Here
Attachm
C. At lease
seven (7) days prior to auction, a notice must be published in a newspaper in the County or City where the sale (public
auction) is advertised to take place. The vehicle make, year, and complete identification number as
well as the date, time and place
of the sale shall be included in the advertisement. Should there be no newspaper published in the county, notice shall be
published in a newspaper of general circulation.
Please Type or Print Clearly
KANSAS
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
www.ksrevenue.org
POSSESSORY LIEN AFFIDAVIT
(Wrecker and/or Towing Service)
KSA 8-1103 through 8-1108
T
HIS FORM MUST BE COMPLETED IN IT’S ENTIRETY
Tow Service Name KCC MCID No.
Address City ST ZIP
Purchaser’s Name , at
Address City ST ZIP
TOW REQUESTED/AUTHORIZED BY
(Must Check One):
Dri
ver
Law Enforc
ement
VEHICLE INFORMATION
Year Make Style VIN
Possessory Date
(Date Towed)
Total Tow & Storage
Bill Accumulated: $
Total Expenses of
Publication and Sale $
Date of the Public Auction Vehicle Selling Price $
Does this vehicle meet the definition of a salvage vehicle as per KSA 8-197(b)(2)(A or B)?
Yes* No
* If yes, a Salvage, Nonhighway or Nonrepairable Vehicle Affidavit, form TR-13, must be completed and attached by seller.
Definition of a salvage vehicle is on the backside of this form.
IF THE VEHICLE OWNER IS KNOWN: Within
15 days of providing the tow service a notice shall be given to the owner
that the vehicle is being held subject to satisfaction of the lien.
Vehicle remaining in the possession of a person providing wrecker or tow service for a period of 30 days after such
wrecker or towing service was provided may be sold pay the reasonable or agreed charges for such recovery,
transportation, protection, storage or safekeeping of such vehicle and personal property (KSA 8-1103).
THE FOLLOWING REQUIREMENTS OF KSA 8-1104 ARE NEEDED TO DISPOSE OF THIS VEHICLE:
A. Not more than 30 days after taking possession of the vehicle, apply for a verification of last registered owner and
lienholder(s), if any, from the Division of Vehicles. If no Kansas record is found, a multi-state search of registered owners and lien
holders must be completed, unless 1. A non-repairable certificate is being applied for in which case form TR-13 must also be attached,
or 2. The vehicle is 15 years of age or older.
B. Notice of sale shall be mailed by certified mail to the registered owner and any lienholder(s) within
10 days
after receipt of the
verification of the last owner and lienholder(s), if any, from the division of vehicles. The notice shall
st
ate th
at if th
e amount due,
together with storage, publication, notice and sale cost, is not paid within 15 days from the date of the mailing, the vehicle and
personal property will be sold at public auction;
I,
the
undersigned, hereby
certify that I am a towing and recovery service as defined by Kansas law, located and doing business in the
state of Kansas at the address shown above. The vehicle listed
on this affidavit
has
remained
in my possession
since the
possessory
date shown to the present time. Towing and recovery charges and the storage
bill have
accumulated
on the
vehicle
and remain unpaid.
Therefore, I claim a lien on said vehicle based on the charges listed in this affidavit. Notice was
given that the vehicle was to be sold at
public auction on the date listed.
I certify under penalty of perjury under the laws of the State of Kansas that the forgoing if true and correct.
Executed on (date):
Possessory Lienholder’s Signature
Handprinted Name of Person Signing Above:
Purchaser must make application for title and registration in the local county treasurer's motor vehicle office in the county in
which the vehicle will be located within 60 days from date of purchase. Purchaser must
submit all documents received from the
tow service to the county treasurer’s motor vehicle office when making application for title and registration.
TR-85 www(Rev. 07/2021)
See Next Page for Additional Requirements
Private Tow
(attach ordinance or resolution)
