Addition to Exemption KSA 79-5107(e) or 50 App. U.S.C.A. § 571 Page 1 of 1
Applicant Name: _________________________ Docket No.: _____________________________
Addition to Exemption Application Military Personnel Vehicles K.S.A. 79-5107(e) or 50 App. U.S.C.A. § 571
1. 2. State your branch of military service. _______________________________________________ Are you in full-time military service? _____No _____Yes If yes, are you absent from this state solely by reason of military orders? _____No
_____Yes
3.
Are you mobilized? _____No _____Yes Date (mm/dd/yy) that you were mobilized:_______________________________ Are you deployed? _____No _____Yes Date (mm/dd/yy) you were deployed:___________________________________ Your state of residence or domicile. _________________________________________________ Provide a copy of a driver's license, voter registration card, or Leave and Earning Statement. Where are you stationed? _________________________________________________________ Provide a copy of the title(s) to the subject vehicle(s).
(Note: Effective January 1, 2003, titles for vehicles subject to liens or security interests are held in electronic format by the Kansas Department of Revenue, Division of Vehicles. If this affects your vehicle and you cannot provide a copy of a paper title, please provide a copy of another document showing the date you acquired the subject vehicle, such as your first registration receipt showing a "Purch/To KS" date or a dated bill of sale.)
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Where is/are the subject vehicle(s) maintained?________________________________________ VERIFICATION
I, ________________________________, do solemnly swear or affirm that the information set forth herein is true and correct, to the best of my knowledge and belief. So help me God.
_______________________________________ Signature of Applicant State of ______________________ County of ____________________
This instrument was acknowledged before me on __________ by _________________________.
Seal ________________________________ Signature of Notary Public
My appointment expires: ________________
Revised 3/09