Form Tc-719 - Sales Tax Exemption Affidavit For Authorized Interstate Carriers - 2001

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Utah State Tax Commission
TC-719
Sales Tax Exemption Affidavit for
Rev. 8/01
Authorized Interstate Carriers
If you have questions, call (801) 297-2200 or toll free 1-800-662-4335. If you need an
accommodation under the Americans with Disabilities Act, contact the Tax Commission at
(801) 297-3811 or (TDD) Telecommunications Device for the Deaf (801) 297-3819. Please
allow three working days for a response.
Purchaser or Lessee Information
Purchaser/Lessee name
Purchase/Lease date
Purchaser/Lessee address
Telephone number
The purchaser/lessee or operator certifies the following:
FOR PURCHASER/LESSEE OF VEHICLES
The purchased/leased vehicle is a qualified vehicle under IFTA and IRP requirements (over 26,000 pounds or three axles), and
will be operated pursuant to the International Registration Plan (IRP) and the International Fuel Tax Agreement (IFTA).
Purchaser/Lessee's
Purchaser/Lessee's
IRP account number _________________________________
IFTA account number _________________________________
AND
FOR PURCHASER/LESSEE OF AIRCRAFT
Purchaser/Lessee is the holder of a certificate issued by the Federal Aviation Administration (FAA) authorizing the holder to engage
in interstate commerce.
FAA operating certificate/air
carrier operating certificate number _________________________________
FOR PURCHASER/LESSEE OF LOCOMOTIVE, FREIGHT CARS, RAILROAD EQUIPMENT, AND OTHER ROLLING STOCK
Purchaser/Lessee is the holder of a certificate issued by the United States Department of Transportation Surface Transportation Board
authorizing the holder to engage in interstate commerce.
Surface Transportation
Board certificate number _________________________________
Under penalties of perjury, the information contained in this affidavit is true, correct, and complete.
Purchaser/Lessee's (or authorized agent) signature
Date signed
X
Seller/Lessor Information
Seller/Lessor's name
Dealer number (sales tax account no.
if lessor)
Seller/Lessor's address
Vehicle/Aircraft/Equipment Information If you are purchasing more than space allows below, attach a separate listing.
Vehicle/Aircraft/Equipment identification or registration number
Year
Make
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Model
Year
Vehicle/Aircraft/Equipment identification or registration number
Make
Model
Year
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
Vehicle/Aircraft/Equipment identification or registration number
Make
Year
Model
WHITE - To the Utah State Tax Commission at the point of registration. (
If unit is sold by a Utah bonded motor vehicle dealer, attach to the Dealer Report of Sale.
)
YELLOW - Seller/Dealer's records
PINK - Purchaser

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