ANN HARRIS BENNETT
Tax Assessor-Collector & Voter Registrar
Harris County Title Service Transactions
This form is prescribed pursuant to Sec. 520.057, Texas Transportation Code.
(Any alterations to this form will cause it to be voided.)
Please complete this printable form online or write legibly in blue or black ink ONLY, within the lines
provided. This form will NOT be accepted and will be returned if it is illegible, altered or incomplete.
Date:
(Date you are conducting business at the Tax Office)
Title Service Name:
(as listed on DBA)
* Enter T/R or RP for the ‘Type’ as follows: ‘T’ = Transfer,’ R’ = Registration Sticker or ‘RP’ = Replacement Plate or Sticker *
Vehicle Identification Number
I swear and affirm that the information provided is accurate to the best of my knowledge. WARNING: Falsifying information on any required statement or government
document is a criminal offense and is punishable by fine and/or imprisonment.
Name of Person Preparing Form (Print) Date Signature of Person Preparing Form Preparer Permit Number
Name of Runner Presenting Form (Print)
Date Signature of Runner Presenting Form Runner Permit Number
TS-5
www.hctax.net
Rev. 03/19
FOR TAX OFFICE USE ONLY
Date: ______ Time: _____ Initials: ______
Title Service Expiration Date: __________
Runner Expiration Date: ______________
Branch Location: ____________________
