Form Vp 203 - Non-Resident, Active Duty Military Governmental Services Tax Exemption Affidavit Form
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1555 Wright Way
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas Area (702) 486-4DMV (4368)
Rural Nevada (877) 368-7828
Website:
NON-RESIDENT, ACTIVE DUTY MILITARY GOVERNMENTAL SERVICES TAX EXEMPTION AFFIDAVIT
Requirements to Claim Exemption - A copy of this form and a Leave Earnings Statement (LES) showing the home state is one other
than Nevada and is dated within the previous 30-days; these must be presented during each registration period. Confidential
information may be blacked out on the LES. If the exemption is being claimed by mail, the LES will not be returned.
(Please type or print)
Part 1 Must be completed by Commander or Authorized Officer
I hereby certify that I have examined the service record of (full legal name of active duty military servicemember)
________________________________________________________________________________________
_____,
First
Middle
Last
Rank _____________________________
_______, last four digits of SS# ____________________ and find that he or
she is a legal resident of the State of __________________________ and a member of ___
__________________ unit
and is assigned to duty at ________________________ __________________________________________
installation effective ____________________________.
Date Ordered to Duty Station
I declare under penalty of perjury that the foregoing is true and correct.
___________________________________________________________
________________________________
Printed Name of Commander or Authorized Officer
Rank
___________________________________________________________
________________________________
Signature (in ink)
Date
(
)____________________________________________________
________________________________
Telephone Number (Mandatory)
Email Address
Part 2 Must be completed by non-resident active duty servicemember claiming exemption
Under the provisions of the Servicemember’s Civil Relief Act of 2003 and the United States Supreme Court decision in the
case of California vs. Buzard, 382 U.S. 386 (1966), I hereby claim exemption for Governmental Services Tax on the
described vehicle registered in ______________________ County, State of Nevada.
_______________ _________________________________________________________________________________
Year
Make
Model
License Plate Number
Vehicle Identification Number
______________________________________________________________________
Full Legal Name
First
Middle
Last
Email Address
Nevada Driver’s License, Identification Number, or Date of Birth
_________________________________________________________
_____________________________________________________________________
Physical Address
Address
City
State
Zip-Code
_____________________________________________________________________
Mailing Address
Address
City
State
Zip-Code
Identification __________________________________________________________________(_____)______________
Driver’s License or State Issued ID Number
State of Issue
Telephone Number
I declare under penalty of perjury that the foregoing is true and correct.
__________________________________________________
__________________________
Signature (in ink)
Date
VP203 (8/2015)
Signatures must be originals. Photocopies are not acceptable.
Changes may not be made to this form once it is signed.
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