KANSAS Here DEPARTMENT OF REVENUE REPOSSESSION …

1 KANSAS DEPARTMENT OF REVENUE DIVISION OF VEHICLES REPOSSESSION AFFIDAVIT Please Type or Print Clearly State of KANSAS , County of Secured Party s Name principal place of business is Address City ST ZIP SECURED PARTY S CONTACT PERSON: Agent s Position w/Secured Party Hand Printed Name of Person Signing Above Date Signature of Authorized Agent VIN Style Make Year Other Debtor(s) Name Date Vehicle was Repossessed Date Security Agreement was Made, Executed & Delivered Email: Phone No.: Title or Position with Secured Party Signature of Authorized Agent This vehicle is currently located in the State of VIN Style Make VEHICLE: Year KANSAS Financial Institution s Name The odometer reading stated is in excess of its mechanical limits s t ne e le pmrahetcHSattA The odometer reading is not actual mileage* *WARNING - ODOMETER DISCREPANCY Exempt Actual Name , of Address City ST ZIP Vehicle was repossessed in accordance to KANSAS statutes and under the terms of the security agreement through.

2 Voluntary Surrender by Debtor Peaceable Seizure Replevin VEHICLE INFORMATION No I, the undersigned, certify to the best of my knowledge that the odometer reading is: Tenth s and this reading is (Must check one of the below): I, the undersigned have read and understand the warning below and hereby certify that: I am authorized to act on behalf of and file this affidavit for the secured party shown above. That a security agreement was made, executed and delivered on the vehicle shown above. A certified copy of the security agreement is attached to this affidavit. Due to default, the secured party did on the date shown above repossess said vehicle in accordance with KANSAS statutes and under terms specified in the security agreement. Therefore, the secured party now claims said vehicle and title document by reason of such default and REPOSSESSION . Reasonable efforts were made to obtain the debtor s certificate of title.

3 By my signature I swear or affirm that the information contained in this affidavit is true and correct, the supporting documentation listed on the back of this affidavit has been attached and all requirements and laws of the State of KANSAS have been complied with. I am aware the law provides severe penalties for making false statement under oath. VIN INSPECTION EXEMPTION When a vehicle is titled and registered outside the State of KANSAS , but is financed originally by a financial institution chartered in the State of KANSAS , and is repossessed in another state and SUCH VEHICLE WILL NOT BE RETURNED TO KANSAS , BY THE FINANCIAL INSTITUTION OR A PURCHASER, BEFORE BEING TITLED IN ANOTHER JURISDICTION, the VIN inspection will not be required for the purpose of obtaining a valid KANSAS REPOSSESSION title.

4 Financial institutions claiming VIN inspection exemption MUST provide the following information as certification of this claim.. I, the undersigned authorized representative of the KANSAS Financial Institution listed herein, have read and understand the warning below and hereby certify: the vehicle described in this VIN Inspection Exemption has been repossessed and WILL NOT BE RETURNED TO KANSAS , BY THE FINANCIAL INSTITUTION OR A PURCHASER, BEFORE BEING TITLED IN ANOTHER JURISDICTION. By my signature I swear or affirm that the information contained in this exemption affidavit is true and correct and that all requirements and laws of the State of KANSAS have been and will be complied with. I am aware the law p rovides severe penalties for making false statement under oath WARNING: KANSAS statutes KSA 21-3711 provides that FALSIFYING INFORMATION ON ANY REQUIRED DOCUMENT IS A SEVERITY LEVEL 8, NONPERSON FELONY.

5 KSA 21-3710 deals with forgery; FORGERY IS KNOWINGLY AND WITH INTENT TO DEFRAUD AND IS SEVERITY LEVEL 8 NONPERSON FELONY. TR-84 www(Rev. 05/22) KSA 8-116a, 8-135 State of KANSAS REPOSSESSION REQUIREMENTS TR-84 (Rev. 03/22) The following are the requirements in the State of KANSAS to repossess a vehicle: The vehicle must be in the lien holder's possession. The owner of the vehicle must be a KANSAS resident and/or the vehicle must have beenfinanced originally by a financial institution chartered in the State of KANSAS . A properly completed application for title must be completed in the county in which thedebtor/lien holder is located. A " REPOSSESSION Affidavit" (TR-84) must be properly and fully completed. If the vehicle was titled in another state or if the VIN (vehicle ID number) is in error, aKansas Highway Patrol Motor Vehicle Examination Certificate" (MVE-1) must beobtained.

6 If the vehicle will not be returned to KANSAS , by the financial institution or apurchaser, before being titled in another jurisdiction, the VIN Inspection Exemptioncertification may be completed and notarized on the REPOSSESSION Affidavit. If theinspection exemption is not completed, the MVE-1 must be following are required and must be attached to the completed REPOSSESSION Affidavit and submitted to the treasurer s office when making application: A certified copy of the security agreement, and one payment schedule. Security agreement must include the vehicle s year, make and complete VIN, the debtor s name and signature. (If the names of two or more persons appear on the back of the title when the security agreement is entered into, and the names are joined by "and", the signatures of both individuals must appear on the certified security agreement.)

7 Verification of title (one of the following): The actual title or Manufacturer's Statement of Origin (MSO) assigned to the debtor andshowing the secured party as lienholder, or A certified copy of the front and back of the title or MSO that was assigned to the debtor andshowing the secured party as lienholder, or A copy of an application for title and registration in any state with the debtor s name shown asthe owner and the secured party s name listed as the lienholder, or Verification of the last registered owner and lienholder, if applicable, obtained from the State ofKansas, a KANSAS County Treasurer or issued by another state, or The KANSAS Division of Vehicles Title and Registration Receipt - Lienholder Copy verifyingapplication for KANSAS Title and Registration has been made If the verification submitted does not show the debtor s name as owner or purchaser andthe name of the secured party that is applying for REPOSSESSION title as lienholder, anotarized disclaimer/release is required from the last registered owner(s) and anylienholder(s).

8 REPOSSESSION titles cost $ , $ title fee and $ REPOSSESSION title there are any questions, please call the Repo Section at (785) 296-3621, menu options 2, and then 4.