Dealer'S Motor Vehicle Inventory Tax Statement I Confidential

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Inslructlons on back o ••orm
®' : " : : : : : -
5()'245 (Rev. 1.96/4)
• {MONTH" YEAR
• • ';;:: 123.122·Rula9.40261
DEALER'S MOTOR VEHICLE INVENTORY TAX STATEMENT I CONFIDENTIAL
TEXAS
78522
Sonl orlgltlal wllh
paymenllO: Counly
Tax
O"1ce
name
and addrus
CAMERON COUNTY TAX OFFICE, PO BOX
952,
BROWNSVILLE,
Sond
copy
10; Applal$81 Olslrid name
and adOreu
CAMERON APPRAISAL DISTRICT, PO BOX
1010,
SAN BENITO,
Step
1:
Owner's
name and
address
Step 3:
Provide the
following
Information
about each
vehicle sold
during the
reporting
month
(continue
on
additional
sheets as
needed).
Owne(sname
I
Own.fs
phone
{arsa
code.5 num!>erJ
Current
mailing
address
(numbsF
/lila
sltss,)
CIIY. 10wn or posl oUIce.
Siale.
ZIP coda
Person
compklUng
alalamenl
Date of
Model
Sale
Year
Description of Vehicle Sold
Make
".
I
TRia
Ident
Vehicle
Number
ification
TEXAS
78586
Step 2:
Infonnatlon
about the
business
Purchaser's Name
Page
of pagea
Phona (IIrN
1:OdIJ"
num!>er)
544-0800
PIlon. (ara
cocIIJ"
ntlll'lll<llr)
399-9322
Give
'ppralnJ
dlslriclllC>COUtlI
ru.mber lIitva"b/e
Of
lIt1ach tax bill
Of
copy
of
IIppralsalor lax
office
QXT8$pOndf/llOt
_rnllg )OIII'lIecount. 111nIIva'-ble.
g/vtIlhe IlrHladdress at ""kh the
property
Is
Iocaled.
Nama 01
each
bUSiness
.
Ac:c:ounl number
InwnlOl)' Iocallon (1WIIIl>er,
~
cJty. .Ia'e.1JP code + 4)
Type
01
I
Sales
I
Unit Property
Sale
1
Price
2
Tax
a
(See
back of page for footnotes.)
!
Total
tor
this
DaDe
onlY
Your general dlsUngulshlng number(s)(GON)
Total Unit
Property
Tax
this month
4
Unit property tax factor you used
Provlda
lhese lolals on last page
only
Step 4:
Total
Sales
Breakdown of sales (number of units sold) for this month
~oc
mOiOf V1Ihlc;Ie
InVllllCQ' Y _1
Fleel Sales
I
Oealer Sales
Breakdown of sales amounts for thIs month
Nel motor
vehicle
kW80lory
I
Fleel Sales
I
:8.1 01
Sales
S
$
I
I
Subsaquenl Sales
I
I
:UbI8
Q
U8n1 Sakis
Step 5:
Sign and
date the
statement
on last page
only
sign.
Signature
loale
here
Under Texas Penal Code, Section
37.10,1f
you make a 'al,e atatement on this
application, you could receive a 'all term
0'
up to 1 yea{ and a line
0'
up
10
$3,000,
or community corr.ctlonal facility confinement of up to
1
yaar, or a
prf,on t.rm of
2
to
10
y.a.... and a nne of up to
$10,000.

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