Form Cert-106 - Claim For Refund Of Use Tax Paid On A Motor Vehicle Purchased From Other Than A Motor Vehicle Dealer Page 2
ADVERTISEMENT
1
2Part II
Purchaser: Read the instructions fi rst, then complete Parts II, III, and IV. Please print clearly.
Name of purchaser
Last
First
Social Security Number
Address
City
State
ZIP code
Name of purchaser (If co-ownership)
Last
First
Social Security Number
Address
City
State
ZIP code
Part III Motor Vehicle Identifi cation and Refund Calculation
Description of Motor Vehicle
____________________________________________ Date of registration _______________________________________
Date of purchase
Make of vehicle _________________________________________________ Model ____________________________Year ____________________
Vehicle Identifi cation Number ____________________________________________ Odometer reading on date of purchase ______________________
Refund Calculation
Multiply the applicable tax rate from the table below by the actual purchase price. Subtract this amount from the tax paid to DMV.
Value used by DMV to compute tax $ ____________________
$ ______________________
Tax paid to DMV
$ ____________________ X _______________
$ ______________________
Actual purchase price
(Enter tax rate from
table below.)
$ _____________________
Refund claimed: tax paid less tax actually due
-
Tax Rate Table
Enter the applicable tax rate for your purchase in the Refund Calculation above
Tax Rate
Tax Rate
6.35% Date of purchase is on or after July 1, 2011 and the purchase
4.5%
Qualifying active duty nonresident member of the military or
their spouse regardless of purchase date;
price is equal to or less than $50,000 before trade-in; or
6%
Date of purchase is on or before June 30, 2011;
7%
Date of purchase is on or after July 1, 2011 and the purchase
price is more than $50,000 before trade-in.
Part IV
Purchaser’s Declaration
I, the purchaser named in Part II, declare that I purchased the motor vehicle identifi ed in Part III from the seller named in Part V. The actual purchase price
of the vehicle was $ ________________________________________ . No other consideration, such as transfers of property other than money or cancellations
or offsets of debts owed by the seller, has been or will be paid or transferred by me in connection with my purchase of the vehicle identifi ed in Part III. I declare
under the penalty of law that I have examined this certifi cate and to the best of my knowledge and belief it is true, complete, and correct. I understand the
.
penalty for willfully delivering a false return to DRS is a fi ne of not more than $5,000, imprisonment of not more than fi ve years, or both
Signature of purchaser _____________________________________________________ Date ___________________________________________
(
)
Print name of purchaser ____________________________________________________ Telephone _______________________________________
And (common)
Or (joint)
If co-ownership, check the appropriate box and enter the information below:
Signature of other purchaser _________________________________________________ Date ___________________________________________
(
)
Print name of other purchaser ________________________________________________ Telephone _______________________________________
Part V
Seller’s Declaration
I, the seller, declare that I sold the vehicle identifi ed in Part III to the purchaser named in Part II. The actual purchase price of the vehicle was
$_______________________________ . No other consideration, such as transfers of property other than money or cancellations or offsets of debts owed to
the purchaser, has been or will be paid or transferred to me in connection with my sale of the vehicle identifi ed in Part III. I declare under the penalty of law
that I have examined this certifi cate and to the best of my knowledge and belief it is true, complete, and correct. I understand the penalty for willfully delivering
.
a false return to DRS is a fi ne of not more than $5,000, imprisonment of not more than fi ve years, or both
Signature of seller _________________________________________________________ Date ___________________________________________
(
)
Print name of seller ________________________________________________________ Telephone _______________________________________
Address of seller ____________________________________________________________________________________________________________
If jointly sold,
Signature of other seller ____________________________________________________ Date ___________________________________________
(
)
Print name of other seller ___________________________________________________ Telephone _______________________________________
Address of other seller _______________________________________________________________________________________________________
CERT-106, Claim for Refund of Use Tax Paid on a Motor Vehicle Purchased From Other than a Motor Vehicle Dealer (Rev. 07/11)
Connecticut Department of Revenue Services
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Ft-500 - Application For Refund Of Sales Tax Paid On Petroleum Products - Nys Department Of Taxation And Finance
Financial
Form Rv-f-1303501 - Application For Refund Of Sales Tax Paid On The Purchase Of All-terrain Vehicles Used As Farm Equipment - Tennessee Department Of Revenue
Financial
Form L-2087 - Application For Refund Of User Fee Paid On Motor Fuel (diesel, Gasoline, Lp) Used In Trucking Equipment
Financial
Form Dtf-803 - Claim For Sales And Use Tax Exemption - Title/registration - Motor Vehicle, Trailer, All-terrain Vehicle (atv), Vessel (boat), Or Snowmobile
Education
Form Dtf-803 - Claim For Sales And Use Tax Exemption Title/registration Motor Vehicle, Trailer, All-terrain Vehicle (atv), Vessel (boat), Or Snowmobile
Financial
Form 72a066 - Application For Refund Of Kentucky Tax Paid On Gasoline Used In Operation Of Aircraft (krs 138.341 To 138.342)
Financial
Related Categories
Parent category: Financial