Form Tr-205b - Temporary Permit Order Form

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Office Use Only
Dealer No.
Folder No.
K
ANSAS
D
R
EPARTMENT OF
EVENUE
D
V
IVISION OF
EHICLES
TEMPORARY PERMIT
D
L
B
EALER
ICENSING
UREAU
915 SW H
ARRISON
ORDER FORM
T
, K
66626-0001
OPEKA
ANSAS
(785) 296-3621
72 Hour Permits
@ $36.00 each =
$
Max. of 3 permits
15 Day Permits
@ $110.00 each =
$
Max. of 3 permits
Dealer Business Name
DBA
Business Address
City
State
Zip
Email Address
Business Phone
Owner Signature
Date
To insure the speedy processing of your order:
Make your check or money order payable to the Kansas Department of Revenue and for
the correct amount.
Your Monthly Sales Reports must be current.
This form is to be used to order 15 day and 72 Hour Permits only
15 day and 72 Hour Permits can be sold to a motor vehicle dealer licensed in this state
or in a state contiguous to this state.
If your dealership has changed its business name and/or business location, please
contact the Dealer Licensing Bureau.
TR205b (4/13)

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