Name of Runner presenting this form (Print)

TS-5 www.hctax.net Rev 2/15 v8

Harris County Title Service Transactions This form is prescribed pursuant to Sec. 520.057, Texas Transportation Code.

FOR TAX OFFICE USE ONLY

Title Service expiration date: _____________ Runner License expiration date:___________

I swear and affirm that the information provided is accurate to the best of my knowledge.

Name of person preparing this form (Print) Date Signature of person preparing this form Texas Driver’s License Number

Date Signature of Runner presenting this form Title Service or Runner Phone Runner Authorization Number

Date: Title Service Name:

Title Service Phone No.

(as listed

Owner (Print):

Authorization Number: Owner (Sign):

Transaction Date Model Model Year Make Vehicle Identification Number License Plate Number Type

** Enter T/R or RP for the ‘Type’ as follows: ‘T’ = Transfer,’ R’ = Registration Sticker or ‘RP’ = Replacement Plate or Sticker

1

2

3

4

5

6

7

8

9

10

(as listed on DBA) (Date you are conducting business at the Tax Office)

Tax Assessor-Collector.&.Voter.RegistrarANN HARRIS BENNETT