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Form 71a103 - Application For Protective Refund Of Motor Vehicle Usage Tax Used Vehicles Purchased Out-Of-State

REV Form

PPLICATION FOR

ROTECTIVE

EFUND OF

OTOR

EHICLE

SAGE

# 71A103

-S

SED

EHICLES

URCHASED

TATE

(04/02)

KENTUCKY REVENUE CABINET MOTOR VEHICLE USAGE TAX SECTION

P.O. BOX 429

FRANKFORT, KY 40602-0429

If your address has changed, please update below:

Owner/Buyer:

Name:

Address:

City:

State:

Zip:

PLEASE MAKE ANY CORRECTIONS BELOW AND PROVIDE ANY MISSING INFORMATION

Your Daytime Phone Number: _____________________________________________________________________________

Used Vehicle Purchased: Year __________ Make ________________________ Model ______________________________

Vehicle Identification Number (VIN#) _______________________________________________________________________

Date of Registration/Date Tags Paid: Month ________________________________________Year ___________________

Gross Motor Vehicle Use Tax Paid __________________________________________________________________________

(If you qualify, your refund will be a portion of this amount less any court ordered fees.)

PART II:

Use this form only to file for a refund of Motor Vehicle Usage Tax for the purchase of the used vehicle

noted at the top of this form. Provide clear and accurate answers. Please print.

The following information and documents will help speed the processing of your refund. Please provide

the requested information, if known, and copies of the requested documents, if you have them. If you

do not enclose a copy of your purchase agreement, you must sign the sworn statement on the back of

this form to be eligible for refund.

1. From whom did you purchase this used vehicle?

Seller Name __________________________________________________________________________________________

City ________________________________________ State __________ Zip Code _______________________________

2. What vehicle(s) did you trade in for the above listed purchase:

(a)

Year/Make/Model (e.g., 1998 Nissan Sentra) ___________________________________________________

Vehicle Identification No.

(b)

Second Trade (if any) Year/Make/Model (e.g., 1998 Nissan Sentra) _____________________________

_______________________________________________________________________________________________

Vehicle Identification No.

3. When you purchased this used vehicle was an Affidavit of Total Consideration used?

Yes

Don’t Know

To speed the processing of your refund, please attach a copy of your purchase agreement to this

form, if available. If you do not enclose a copy of your purchase agreement, your refund may be

reduced by an additional administrative fee.

PLEASE USE THE ENCLOSED WINDOW ENVELOPE TO MAIL YOUR COMPLETED FORM BY JULY 31, 2002.

Fold On Line

Please make sure

that address and

barcode appear in

windows when

returning

Kentucky Revenue Cabinet

Motor Vehicle Usage Tax Section

P.O. Box 429

Frankfort, KY 40602-0429

|406020429292|

Questions? Call toll free 1 (877) 347-4784.

Form 71a103 - Application For Protective Refund Of Motor Vehicle Usage Tax Used Vehicles Purchased Out-Of-State

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