CLAIM FOR SALES or USE TAX REFUND
CREDIT FOR SALE OF USED VEHICLE
This form is to be used by persons qualifying under Act 1232 of 1997, as amended. See reverse side for complete instructions.
Name
Address
City
State
ZIP
Description of Vehicle Purchased: Year _______, Make _______________, Model ____________________
Type Veh Purch
A=Car,Passenger Truck,RV,Bus,etc. T=Commercial Truck1 ton & up S=Trailer M=Hwy Use Motorcycle
VIN of Vehicle Purchased
Date Purchased
Purchase Price
Description of Vehicle Sold: Year _______, Make, _________________Model ________________________
Type Veh Sold
A =Car,Passenger Truck,RV,Bus,etc. T=Commercial Truck1 ton & up S=Trailer M =Hwy Use Motorcycle
VIN of Vehicle Sold
- -
Date Sold
Selling Price
As an owner of the vehicles purchased and sold, I hereby swear and affirm that the information provided is true and correct. I understand that
if there is a joint ownership shown on the tax receipt, this claim is made on behalf of all owners. Separate claims from joint owners shall not
be allowed. I understand that any attempt to evade or defeat the payment of the proper amount of tax by making false statements is a felony
under Arkansas law, punishable by fine, imprisonment, or both.
IMPORTANT: To prevent a delay of your refund, the following documents must be attached to this form: 1) A legible copy of the Vehicle
Registration Certificate/Tax Receipt issued by the Revenue Office for the vehicle purchased 2) a copy of the bill of sale for the vehicle
purchased and 3) a copy of the bill of sale for the vehicle sold which includes the sale date, sale amount, names and addresses.
____)_____________
__________________________________
_____________
(
(Signature of Claimant)
(Date)
(Telephone #)
- -
Claimant’s SSN or FEIN
Mail this form and required documents to: Tax Credits/Special Refunds Section, PO Box 8054, Little Rock, AR 72203
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Do Not Complete, For Office Use Only:
-
- -
Date Recd
Date Paid
Receipt#
Car Purchased : __________________ - Car Sold : ________________ = Taxable Amt : ________________
State Tax:
St Paid
Due ___________
St Refund ____________
____%
Local 1
L1 Paid
Due ___________
L1 Refund ____________
____%
Local 2
L2 Paid
Due ___________
L2 Refund ____________
1 %Texarkana
46-10
Tx Paid
Due ___________
Tx Refund ____________
Rej Code
Tx
Pn
In
Total Refund _____________
Examiner
Date___/___/___ Posted_________
Form 10-448 (R 08/2001)