Kansas Form D 14 – Fill Out and Use This PDF

KANSAS DEPARTMENT OF REVENUE

FOR OFFICE USE ONLY: FOLDER # ___________________

DIVISION OF VEHICLES

DEALER LICENSING BUREAU

FEE INCREASES EFFECTIVE JANUARY 1, 2013

DOCKING STATE OFFICE BUILDING

1ST DRIVE AWAY PLATE

$54.00

TOPEKA KANSAS 66626-0001

Add’l DRIVE AWAY PLATES

$28.00 each

(785) 296-3621

REPLACEMENT PLATES

$28.00 each

1st Drive Away Plate (To be paid only once a year)

$

#_____ Additional Plates

$

Total Fees Due

$

APPLICATION FOR KANSAS DRIVE-AWAY TRANSPORTER PLATES(S)

Owner Name:

SSN:

Last

First

Middle

Residence Address:

Street Address

City

State

Zip

Residence Phone: (

)

D i e ’s Li e se #:

Date of Birth:

/

/

Sex:

M

F

Business Name:

Business Address:

Street Address

City

County

State

Zip

Email Address:

Business Phone: (

)

K.S.A. 8-143 Drive Away Transporter Plate definition: A t a

spo te deli e i g

ehi le

ot said t a spo te ’s o

y the d i e-away

method where such vehicles are being driven, towed, or transported singly, by the saddlemount, towbar, or fullmount methods or by any lawful combination thereof, may apply for license plates which may be transferred from one such vehicle or combination to another for each delivery without further registration.

COPY OF LIABILITY INSURANCE CERTIFICATION MUST BE ATTACHED

(False certification constitutes a class B misdemeanor)

I, the above named individual (or authorized representative of the above named firm) do hereby certify that there is in effect and ill e ai tai ed o ti uously th oughout the t a spo te ’s appli atio pe iod, fi a ial se u ity as e ui ed y la .

Further certification is made that the statement made in the above and foregoing application are true and correct and that I qualify for said license plates for use as described in K.S.A. 8-143.

Drive Away plates will be used for: (explain)

*Please Note: Drive-Away plates run January 1 through December 31 of each calendar year. If a Drive-Away plate is lost or stolen, you must contact the Kansas Highway Patrol to report the plate(s) as lost or stolen. A copy of the report and second application must be completed and sent in with the replacement fee to the above address. Please indicate which plates are lost/stolen.

Lost/stolen plates:

DRIVE AWAY LICENSE PLATES SHALL NOT BE USED ON ANY VEHICLE(S) TITLED IN THE COMPANY’S OR OWNER’S NAME. MIS-USE

OF SUCH PLATES COULD RESULT IN THE CANCELLATION AND DENYING YOUR DRIVE-AWAY REGISTRATION AND PLATES.

Signature of Owner/Authorized Representative

Printed Name

Date

FOR ADDITIONAL OWNER INFORMATION SEE BACKSIDE

D-14 (Rev 12/12)