Form Vp 154 - Application For Governmental Services Tax Exemption Vp 154)
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1555 Wright Way
Carson City, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
APPLICATION FOR GOVERNMENTAL SERVICES TAX EXEMPTION
(Nevada Tribal Members Residing on Reservation within the Boundaries of Nevada)
Instructions:
This application for exemption must be submitted for each registration period.
Separate applications are required for each vehicle. The application for exemption must be presented at the time of
registration or renewal.
A Tribal Chair of a Nevada Indian Tribe must certify that the applicant meets the eligibility criteria for Governmental Services
Tax exemption.
Eligibility:
The registered owner of the vehicle must be a member of a recognized Nevada tribe.
The vehicle must be located (based) on Nevada tribal land. The physical address for the vehicle registration must be located
on tribal land within the boundaries of the State of Nevada.
Please Print or Type
Vehicle Year _____________________ Make ___________________________________________
Model ___________________________ License Plate Number______________________________
Vehicle Identification Number:
Full Legal Name
Last
First
Middle
Nevada Driver’s License, Identification Card Number, or Date of Birth _________________________________________
Physical Address
Address
City
State
Zip Code
Mailing Address
Address
City
State
Zip Code
Telephone (optional) ________________________
E-mail (optional) __________________________
I declare under penalty of perjury that the foregoing is true and correct.
Executed on
Date
Applicant Signature
I declare under penalty of perjury that the forgoing is true and correct and that the applicant
meets the eligibility requirements listed above.
Tribal Chairman’s Name (Print)
Tribal Agency
________________________________________________________________________________________________
Tribal Chairman’s Signature
Date
For DMV Use Only
Technician Number: _________ Super Trans. Number:____________
Date: _________ Exemption Amount: $ _________
VP154 (Rev. 11-2014) Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once it is
signed.
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