Form St-137ac - Affidavit Of Exemption By A Nonresident For Out-Of-State Delivery Of Aircraft To Be Registered And/or Titled Outside The State Of Indiana

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Indiana Department of Revenue
Form ST-137AC
Affidavit of Exemption by a NONRESIDENT
State Form
for Out-of-State Delivery of Aircraft
(7-06)
to be Registered and/or Titled Outside the State of Indiana
Purchaser's Information and Affidavit
Social Security # or Federal ID #
Name of Purchaser
Address
C
y t i
S
a t
e t
Zip Code
I hereby certify under penalty of perjury that I am not a resident of the State of Indiana and that the Aircraft
described below will be removed from the State of Indiana within 30 days of delivery and that the aircraft
will be registered/titled in the state/country of _____________________.
Printed Name and Title
u P
c r
a h
e s
s ' r
S
g i
a n
u t
e r
Date
Description of Aircraft Purchase
Year
Total Sale Price
$
(plus options/dealer prep)
Make
Model
Trade-In Allowance
$
(Aircraft only)
Serial Number
N
FAA Number
Net Sale Price
$
Description of Aircraft Trade-in
FAA Number
Aircraft Make & Model
Aircraft Serial Number
N
Seller's Information and Affidavit
Name of Seller
Address
For more information
City
about this form
contact the Department at:
State, Zip Code
(317) 232-1497
Indiana Retail Merchant Number
Dealer #
I certify under the penalty of perjury that the information contained in this form is true, correct and complete to the
best of my knowledge and belief.
S
e
e l l
s ' r
S
g i
a n
u t
e r
Printed Name and Title
Date
Instructions:
The purchaser's signature, Social Security Number or Federal ID Number, the
name of the state where the aircraft purchased is being taken and the seller's signature must
Indiana Department of Revenue
be shown on this form ST-137AC or the sales tax exemption is invalid. The seller will be held
P.O. Box 644
liable for sales tax on invalid exemptions. Also, this Certification of Exemption for Out-of-State
Indianapolis, IN 46206-0644
Delivery must be properly completed and executed in duplicate. A copy is to be retained by the
seller. The seller must mail the original copy within 30 days to:

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