Affidavit of Fact Form - Kansas
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
AFFIDAVIT TO A FACT
Complete vehicle information, check and complete appropriate statement(s). Must also
complete the Affiant’s Certification at the bottom of the form.
Please Type or Print Clearly
VEHICLE INFORMATION Must be Completed
Year Make ID #
VEHICLE GIFT CERTIFICATION (Used when vehicle or trailer is given as a gift and t he recipient is not a relative.)
I, the undersigned, certify that I am the owner of the above referenced vehicle was presented as a gift to:
ONE AND THE SAME PERSON (Used when a person’s name changed or is incorrect. EX: Jim/ James; Name Changed by Marriage)
I, the undersigned, certify that
are one and the same person.
DISCLAIMING VEHICLE OWNERSHIP (Used when the purchaser shown on the title assignment is renouncing ownership. )
I, the undersigned, certify that I am disclaiming ownership as shown on the assignment of title for the above referenced
TITLE OR MSO ASSIGNMENT (Used when adding a name(s) to the tit le assignment aft er t he assignment was completed.)
We, the undersigned, certify the above referenced vehicle assignment was not properly completed at time of purchase.
Name of person to be added
on assignment as purchaser:
(All parties to be listed as purchasers must sign below.)
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 t he vehicle t o not be in operation from June of one year [sample 2001] until or af ter May of the following year [sample 2002])
I, the undersigned, certify that the above referenced vehicle was not Beginning:
at any time operated during the registration year(s) shown to the right: Ending:
RELATIVES OF A MEMBER OF THE MILITARY (Used when a family member is renewing the registration for a member of the
U.S. military. Person signing must follow the order listed. KSA 8-129)
I, the undersigned, certify that I am the (Must Check One): Spouse; Parent; Eldest Brother or Sister
, a member of (branch of service) .
ANTIQUE MODEL YEAR LICENSE PLATE (Used when registering an antique vehicle with a model year Kansas license plate.)
License Plate Informati Year on Plate on: Plate Number
All Letters and Numbers Must be Shown
I, the undersigned, certify that the license plate listed above is a legible and serviceable license plate, originally issued by the state of
Kansas and the expiration year inscribed thereon corresponds to the model year when the antique vehicle was manufactured.
I certify under penalty of perjury that all information and statement(s) made above are true to the best of my knowledge.
Printed Name of Person(s)
that Signed Above Date
TR-12www ( Rev. 05/07) Previous versions of this form are subject to requirements listed herein.
Current form at: www.ksrevenue.org/pdf/forms/tr12.pdf KS Division of Vehicles will make the final determination if the form is properly completed
BILL OF SALE Must be fully completed
This Bill of Sale is an affidavit of the amount of money or value that was exchange between the seller(s) and buyer(s) for the vehicle listed
ONLY antique vehicles (vehicles 35 years old or older) can have the ownership transferred (sold) by bill of sales. All other vehicles sold by or
purchased from a Kansas resident must have the ownership transferred (sold) by assigned title.
$ Date of Sale:
By our signatures, we swear and affirm the above stated purchase price is true and accurate under penalty of perjury. I am
aware that the law provides severe penalties for making false statements under oath.
Signature of Seller:
Signature of Buyer:
ANTIQUE VEHICLE TRANSFER OF OWNERSHIP
This section of the bill of sale is to be used to transfer ownership of an antique vehicle (vehicle that is 35 model years old or older) when there
is no Kansas title for the vehicle in the name of the owner/seller. All information in the bill of sale above and the antique vehicle transfer of
ownership below MUST be complete for this to be a valid assignment of ownership.
If a non-Kansas resident owns the antique vehicle and the vehicle is not maintained/garaged in Kansas, the ownership of the vehicle must be
transferred according to the laws of the seller’s home state of residence.
I, the undersigned, certify that I am the owner of this antique vehicle, which is listed above, and on this day I have sold and
am transferring ownership of this vehicle to
listed above as buyer.
To the best of my knowledge, no title has been issued in my name for this vehicle in any titling jurisdiction.
I further certify that I will guarantee this vehicle 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 superior to my title.
Date vehicle was Signature
sold and delivered:
Month Day Year of Seller:
TO BUYER: All 1950 or newer antique vehicles sold on a bill of sale must obtain an MVE-1, (Motor Vehicle Examination)
issued by the Kansas Highway Patrol or their designee and submit the MVE-1 with this bill of sale when applying
for antique title. Application for title must be made within 30 days of the purchase date in the county treasurer’s
motor vehicle office in the county in which the vehicle will be located/garaged. Penalty will be assessed on and
after the 31