Fillable VEHICLE GIFT CERTIFICATION - Used when vehicle or

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VEHICLE GIFT CERTIFICATION - Used when vehicle or

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KANSAS DEPARTMENT OF REVENUE
AFFIDAVIT TO A FACT
ksrevenue.gov
Complete vehicle information, check and complete appropriate statement(s) and the Aant’s Certication
at the bottom of the form.
Vehicle Information:
Year _______________________________ Make ________________________________________________ ID # ________________________________________________________________________________
VEHICLE GIFT CERTIFICATION - Used when vehicle or trailer is given as a gift and the recipient is not a relative.
Gift is to: _______________________________________________________________ Owner’s hand printed name: _________________________________________________________
ONE AND THE SAME PERSON - Used when a person’s name changed or is incorrect.
Name as listed on title _________________________________________________________________ Legal Name _____________________________________________________________
DISCLAIMING VEHICLE OWNERSHIP - Used when disclaiming ownership as shown on the assignment of title found
on the backside of Certicate of Title, for the above referenced vehicle
TITLE OR MSO ASSIGNMENT - Used when adding a name(s) to the title assignment after the assignment was completed.
All parties to be listed as purchasers must sign below.
Name of person being added to title __________________________________________________________________________________________________________________________________
VEHICLE NON-USE - Used when registering or renewing vehicle registration and the vehicle was not operated for a full
registration year. EX: A June expiration requires the vehicle to not be in operation from June of one year until after May
of the following year.
Dates vehicle was not in use:
Beginning: Month ____________________________________ Year ______________ Ending: Month ________________________________ Year _______________
RELATIVES OF A MEMBER OF THE MILITARY - Used when a family member is renewing the registration for a
member of the U.S. military.
I am the (must check one): Spouse Parent Eldest Brother or Sister of____________________________________________
ANTIQUE MODEL YEAR LICENSE PLATE - Used when registering an antique vehicle with a model year Kansas
license plate.
License Plate Information: Year on Plate ________________ Plate Number _______________________________________________________________________
All Letters and Numbers Must be Shown
AFFIANT’S CERTIFICATION
I certify under penalty of perjury that all information and statement(s) made above are true to the best of my knowledge.
Aant’s Signature ________________________________________________________________________________________________________________________________________________________________________
Aant’s Signature ________________________________________________________________________________________________________________________________________________________________________
Printed Name of Person(s) that Signed Above ____________________________________________________________________________ Date __________________________________
TR-12 (Rev. 12-21)
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VEHICLE GIFT CERTIFICATION - Used when vehicle or

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Completed 11 March 2022

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