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Print Form APPLICATION FOR TITLE-APPORTIONED REGISTRATION MAIL TO MOTOR CARRIER SERVICES BUREAU 915 SW Harrison Rm 150 TOPEKA KS 66612 Select Application Type Title Only-Leasing to Out-ofState Carrier FOR OFFICE USE ONLY RECORD VEHICLE ID NUMBER TRK or TRL VEHICLE NEW USED ASSEMBLED Ownership Change-Staying on Same KS IRP Account FORMERLY NON-HIGHWAY or SALVAGE THIS MUST BE COMPLETED BEFORE SUBMITTING - Type or Print VEHICLE OWNERSHIP MUST BE THE SAME AS THE ASSIGNMENT ON THE TITLE Application Date Transaction Date Month/Day/Year LESSOR R NAME Last First Middle Initial LESSEE E AND OR AND/OR / IN CARE OF. DBA D WROS W ORIGINAL-Adding to IRP Account Address City State County Zip Code SPECIAL MAIL OUT Name Adress City State Zip Code 1st Leinholder Name 1st TOD Name 2nd TOD Name City State Zip code 2nd Leinholder Name I do hereby certify that I have in effect and will maintain continuously throughout the registration period financial security as required by law for the above described vehicle. I further certify that al liens and/or encumbrances if any are listed and the information on this application is true and correct to the best of my know ledge and belief. FALSE CERTIFICATION CAN RESULT IN CRIMINAL PROSECUTION. IF AND OPTION IS SELECTED UNDER OWNER ENTRIES THEN ALL OWNERS MUST PROVIDE THEIR SIGNATURES BELOW SIGNATURE OF OWNER S Model Year Type HT or TR Make Empty Weight Body Style TR or Gross Weight 80 000 Orig/Supp Carrier Account Sales Tax Paid Yes No Acquired By MSO MCS-63 11/06 Class Code Mileage Status Mileage CT T Issued Title Sales Tax No. ICC MC No. Exempt Assigned Title Jurisdiction Other. Print Form APPLICATION FOR TITLE-APPORTIONED REGISTRATION MAIL TO MOTOR CARRIER SERVICES BUREAU 915 SW Harrison Rm 150 TOPEKA KS 66612 Select Application Type Title Only-Leasing to Out-ofState Carrier FOR OFFICE USE ONLY RECORD VEHICLE ID NUMBER TRK or TRL VEHICLE NEW USED ASSEMBLED Ownership Change-Staying on Same KS IRP Account FORMERLY NON-HIGHWAY or SALVAGE THIS MUST BE COMPLETED BEFORE SUBMITTING - Type or Print VEHICLE OWNERSHIP MUST BE THE SAME AS THE ASSIGNMENT ON THE TITLE Application Date Transaction Date Month/Day/Year LESSOR R NAME Last First Middle Initial LESSEE E AND OR AND/OR / IN CARE OF. DBA D WROS W ORIGINAL-Adding to IRP Account Address City State County Zip Code SPECIAL MAIL OUT Name Adress City State Zip Code 1st Leinholder Name 1st TOD Name 2nd TOD Name City State Zip code 2nd Leinholder Name I do hereby certify that I have in effect and will maintain continuously throughout the registration period financial security as required by law for the above described vehicle. I further certify that al liens and/or encumbrances if any are listed and the information on this application is true and correct to the best of my know ledge and belief* FALSE CERTIFICATION CAN RESULT IN CRIMINAL PROSECUTION* IF AND OPTION IS SELECTED UNDER OWNER ENTRIES THEN ALL OWNERS MUST PROVIDE THEIR SIGNATURES BELOW SIGNATURE OF OWNER S Model Year Type HT or TR Make Empty Weight Body Style TR or Gross Weight 80 000 Orig/Supp Carrier Account Sales Tax Paid Yes No Acquired By MSO MCS-63 11/06 Class Code Mileage Status Mileage CT T Issued Title Sales Tax No* ICC MC No* Exempt Assigned Title Jurisdiction Other.

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