KANSAS DEPARTMENT OF REVENUE
REQUEST AND CONSENT FOR KANSAS TITLE TO BE ISSUED
WITH LIEN AND MAILED OUT OF STATE
www.ksrevenue.org
Vehicle Information:
Year: Make: License Plate Number:
VIN:
Owner Information:
Owner Name(s):
Owner Address:
New/Current Street Address City State Zip
Street Address City State Zip
Note: Owner’s new address MUST be in the state the vehicle is going to be titled and registered. The title will not be mailed to this address.
Lien Holder Information:
Lien Holder Name:
Lien Holder Address:
By the affixed, the lien holder listed herein consents and
approves the Kansas Titles and Registrations Bureau to
issue a Kansas certificate of title showing this lien and
mail the Kansas title directly to the new titling jurisdiction.
Sworn and signed before me on this day of , 20
Notary Public:
Commission Expires:
Place Notary Seal Here:
Authorized
Agent:
Vehicle Titling Agency (DMV) for the jurisdiction of requests that the State
of Kansas issue a certificate of title in the name of the owner(s) listed herein with the lien for the above lien holder and
mail same directly to the DMV office shown below:
Name of
DMV Office: Attn:
Street Address City State Zip
Authorized
Associate
Name Hand
Printed: Date:
Instructions
The Kansas certification of title will be issued when both the lien holder and titling jurisdiction complete this form and it is received
by the Kansas Titles and Registrations Bureau.
The lien holder listed on the Kansas title recorded, and the new titling jurisdiction must complete their portion of this form.
The lien holder must consent to a Kansas certificate of title being issued with their lien listed and surrendered directly to the new
titling jurisdiction. The consent must be notarized. Title will not be mailed to the lien holder or owner.
The new titling jurisdiction must request the Kansas certificate of title be issued and mailed to their office for title and registration
purposes.
Mail or fax the completed form to the Kansas Titles and Registration Bureau. Please do not fax and mail. Fax only once. Fax to
785-296-3852 OR mail to Kansas Department of Revenue, Division of Vehicles, P.O. Box 2505, Topeka KS 66601-2505.
The same information may be provided on the lien holder and titling jurisdiction’s letterhead, however, the information must be
received in Kansas Titles and Registration at the same time.
NOTE: If the application for Kansas certificate of title has not been completed by the owner, the title cannot be issued until it has been
completed. The title cannot be mailed to the lien holder or owner.
TR-42 (Rev. 11/18)
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