KANSAS
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
www.ksrevenue.org
OWNERSHIP AFFIDAVIT
for
VEHICLE - TRAILER - ANTIQUE - MOTOR
STATE OF KANSAS ) K.S.A. 1985 Supp. 8-142 provides a
) penalt
y for knowingly making a false
COUNTY OF
) statement or concealing a material fact.
ATTESTING OWNERSHIP OF A: Mobile Home (House Trailer)
(Must Check One)
All-terrain vehicle (ATV)
Micro Utility Truck
Trailers 2000 lbs and under
Boat Trailer
Work-Site Utility Vehicle
I, the undersigned, certify that the vehicle hereinafter described has not, to my knowledge, been previously titled or registered in
any State.
Make
Year Style Weight or Dimensions
VIN I have owned this vehicle/trailer since (year):
ATTESTING OWNERSHIP OF AN ANTIQUE: Passenger Vehicle Truck
(Check one.)
Motorcycle Antique Military Vehicle
I, the undersigned, certify that I am the owner of the following vehicle:
Make Year Style Weight VIN
Having purchased said vehicle for a good and valuable consideration from:
Name
Address
on Month Day Year . I have held possession of this vehicle since said date.
Antique vehicles, with a model year of 1950 or after, using this form or a bill of sale must obtain and attach
an MVE-1 (Motor Vehicle Examination) issued by the Kansas Highway Patrol to this affidavit before applying
for antique vehicle title at your local county treasurer’s motor vehicle office.
ATTESTING OWNERSHIP OF A MOTOR.
I, the undersigned, certify that I am the lawful owner of a motor from a; Year Make
Identification
Number
, having purchased said motor for a good
and valuable consideration from:
Name
Address
on Month Day Year . I have held possession of this motor since
said date. At the time of said purchase, the seller executed and delivered to me a bill of sale for said motor and the bill of sale is
hereto attached.
AFFIANT’S CERTIFICATION - REQUIRED
I certify I will guarantee the title to this vehicle/trailer/motor to be free and clear from all defects, liens or encumbrances of any nature
whatsoever and that I will indemnify any subsequent purchaser of same for any loss sustained should anyone prove ownership of said
vehicle/motor superior to my title.
By my signature I swear or affirm that this is a true and correct statement. I am aware that the law provides severe penalties for
making false statements under oath.
Affiant’s
Signature
Affiant’s Hand
Printed Name
Date
TR-90 (Rev. 04/21)
