Form Mcs-105 - Application For Refund Of Kansas Apportioned Fleet Registration - 1999

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APPLICATION FOR REFUND OF KANSAS APPORTIONED FLEET REGISTRATION
KANSAS DEPARTMENT OF REVENUE
SSN or FEIN
DIVISION OF VEHICLES
MOTOR CARRIER SERVICES BUREAU
DOCKING STATE OFFICE BLDG., BOX 12003
Apportioned Account Number
TOPEKA, KANSAS 66612
785-291-3384
NAME
MAILING ADDRESS
CITY AND STATE
ZIP
Application for refund of the balance of Kansas registration fees and/or THE CANCELATION
OF ANY REMAINING APPORTIONED FLEET QUARTERLY PAYMENT INSTALLMENTS FOR THE
following described apportioned vehicle(s) as provided in K.S.A. 8-1,116(c).
20___
YEAR
VEHICLE
*BASIS FOR
IF SOLD
DATE
PLATE
MADE
MAKE
IDENTIFICATION
REFUND OR
NAME OF PURCHASER
OF
NO.
NUMBER
CANCELLATION
AND ADDRESS
SALE
*BASIS FOR REFUND AND/OR CANCELLATION: Motor Vehicle has been SOLD, REPOSSESSED, JUNKED
FORECLOSED BY MECHANIC’S LIEN, OPERATION OF LAW, OWNER DECEASED. Indicate in this column the
reason a motor vehicle is no longer in your possession. See reverse side, for REQUIRED DOCUMENTS to be
filed with this application, and prerequisites to obtaining a refund or cancellation under proportional
fleet registration.
The KANSAS APPORTIONED REGISTRATION CAB CARD(s) and KANSAS APPORTIONED
LICENSE PLATE(S), and any supporting documents MUST BE RETURNED with this application.
The undersigned under oath swears and affirms that the above information is true and correct.
X
OWNERS SIGNATURE OR AUTHORIZED REPRESENTATIVE
TITLE
Subscribed and sworn to before me this ______ day of ______________, 19 __.
X
NOTARY SEAL
NOTARY PUBLIC
My Commission Expires
MCS-105 (REV. 9/99)
SEE INSTRUCTIONS, REVERSE SIDE

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