Harris County Title Service Records
This form is prescribed pursuant to Sec. 520.057, Texas Transportation Code.
Instructions: Attach a completed copy of this form to form TS-5 for each transaction listed.
Customer # 1
Name: ______________________Age____ Sex ____
Address: ____________________________________
City________________________ St.___ Zip________
Printed name of person preparing this form
TS-5A
Rev. 08/13
Legible copy of proof of financial responsibility
(insurance card)
If unable to copy in this designated space,
attach a copy of proof of insurance to this form.
Legible copy of Driver’s License
(Customer #1)
Legible copy of Driver’s License
(Customer #2)
Name of Service: ___________________________
Authorization No.:___________________________
Title Service Transaction Date: ______________________
License Plate
Number: _____________________________
VIN: ___________________________________________
If unable to copy in this designated
space, attach a copy to this form.
If unable to copy in this designated
space, attach a copy to this form.
Customer # 2
Name: ______________________Age____ Sex ____
Address: ____________________________________
City________________________ St.___ Zip________
Signature
of person preparing this form Date
