Form Tc 96-215 - Affidavit Of Motor Vehicle Assembled From Wrecked Or Salvaged Motor Vehicles
ADVERTISEMENT
1
2Submit in Duplicate
TC 96-215
KENTUCKY TRANSPORTATION CABINET
Rev. 3/96
DEPARTMENT OF VEHICLE REGULATION
Division of Motor Vehicle Licensing
Frankfort, Kentucky 40622
AFFIDAVIT OF MOTOR VEHICLE
ASSEMBLED FROM WRECKED OR SALVAGED MOTOR VEHICLES
STATE OF KENTUCKY, COUNTY OF ___________________________________________________________________________
The affiant, ______________________________________________________________________________________________
(Name)
____________________________________
_____________________________________
_____________________________
(Street or P.O. Box)
(City or Post Office)
(County)
Kentucky, states that a motor vehicle has been reconstructed from parts taken from other motor vehicles which have been
obtained from
___________________________________________________________________________________________________________
________________________________________________________________________________________________________ * ;
that said vehicle is described as follows:
VEHICLE DESCRIPTION
Vehicle Identification Number
Make
Model No.
Style Body
Year Model
If Motorcycle – Motor Number ____________________________
And that he is the sole owner of the motor vehicle which has been thus produced, which is clear of all liens.
Signed ______________________________________________
_________________________________________
(Affiant)
(Title)
Subscribed and sworn to before me this _________ day of
Signed _________________________________________
(Attesting Official)
_____________________________ , 20 _________ .
_________________________________________
My commission expires _____________________________
Official Title _________________________________________
•
In accordance with KRS 186A.990: Any person who knowingly gives false, fraudulent, or erroneous information in
connection with an application, and when required, titling of a vehicle, or any application for assignment of a vehicle
identification number, or replacement documents, shall be guilty of forgery in the second degree.”
(continued)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Tc-810 - Exemption Affidavit Of Utah Safety And Emission Requirements For Vehicles Not In Utah -2006
Financial
Form Tc-810 - Exemption Affidavit Of Utah Safety And Emission Requirements For Vehicles Not In Utah
Financial
Form Tc-810 - Exemption Affidavit Of Utah Safety And Emission Requirements For Vehicles Not In Utah - 2000
Financial
Form Dhcs 0010 - California Affidavit Of Identity For U.s. Citizen Or National For Disabled Individuals Living In Institutional Care Facilities - Health And Human Services Agency
Legal
Form Dhcs 0009 - California Affidavit Of Identity For U.s. Citizen Or National Children Under 18 (armenian) - Health And Human Services Agency
Legal
Form Dhcs 0009 - California Affidavit Of Identity For U.s. Citizen Or National Children Under 18 (chinese) - Health And Human Services Agency
Legal
Related Categories
Parent category: Legal