Form Mcs-63 - Application For Title-Apportioned Registration
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1APPLICATION FOR TITLE-APPORTIONED REGISTRATION
COMPLETE BY TYPEWRITER. NO CARBONS REQUIRED
MAIL TO: KANSAS DEPARTMENT OR REVENUE, DIVISION OF VEHICLES,
MOTOR CARRIER SERVICES BUREAU, BOX 12003, TOPEKA, KS 66612-2003
FOR OFFICE USE ONLY
VEHICLE ID #
CNTY
TRK/TRL
ORIGINAL
VEHICLE:
NEW
USED
ASSEMBLED
THIS MUST BE COMPLETED BEFORE SUBMITTING - (Type or Print) RETURN BOTH COPIES
Application Date
Purchase Date
(Month/Day/Year)
(Month/Day/Year)
AND
OR
AND/OR
DBA
NAME
&
*
%
**
Last
First
Middle Initial
AND
OR
AND/OR
DBA
WROS
NAME
&
*
%
**
,
Last
First
Middle Initial
NAME
Last
First
Middle Initial
Address
City
State
Zip Code
Leinholder
Address:
City, State, Zip
Leinholder
Address
City, State, Zip
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, and that the information in this application is true and correct to the best
of my knowledge and belief. FALSE CERTIFICATION CAN RESULT IN CRIMINAL PROSECUTION.
SIGNATURE OF OWNER
FOR OFFICE USE ONLY
Model Year
Make
Body Style
Class Code
Type
Empty Weight
Gross Weight
Mileage
*Mileage Status
*Mileage Status: A=(Actual) E=(Estimated) X=(Exceed Maximum Mileage) T=(Exempt)
Orig/Supp# ____________________ Carrier Account # ____________________
Issued Title# ___________
Sales Tax Paid: Yes __ No __
Sales Tax No. ________________________
ICC MC No. ___________ Other __________
Acquired By: MSO _______________
Assigned Title _______________
Other _______________
Transaction Number:
MCS-63 (Rev. 7/99)
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Parent category: Financial