Form Dr-42b - Ownership Declaration And Sales And Use Tax Report Of Vessel Purchase

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DR-42B
Ownership Declaration
N. 10/96
and Sales and Use Tax Report of Vessel Purchase
____________________________________________
__________
_________
__________
_______________________________
Name of Vessel
Year
Make
Model
USCG Documentation or State Reg.#
_______________________________________________________________________________
_____________________________________
Name of Purchaser
Florida Sales Tax Registration Number
_______________________________________________________________________________
(________) ___________________________
Address
Daytime Telephone Number
_______________________________________________________________________________
_____________________________________
City
State
Zip
The vessel described above was purchased from _________________________________________________________________________________
Name of Seller, Dealer or Broker
_______________________________________________________________________________
_____________________________________
City
State
Zip
Delivery was accepted at _________________________________________________ on the________ day of __________________ 20 __________
Name of Marina, boat yard, etc.
Present Location of Vessel ___________________________________________________________________________________________________
_______________________________________________________________________________
_____________________________________
City
State
Zip
Indicate the total purchase price, including any unpaid balance due seller, bank or finance company. Include the total consideration valued in money,
whether paid in money or otherwise.
Total Purchase Price
$
_______________________________
Less: Trade-in (if applicable)
_______________________________
Net Purchase Price
_______________________________
Florida Tax Due (6%)
_______________________________
Florida Discretionary Surtax (see Attachment)
_______________________________
Less: Florida Tax Paid (attach copy of receipt)
_______________________________
Less: Taxes Lawfully Imposed and Paid to Another State:
_______________________________
(attach copy of receipt)
Balance Due
_______________________________
Penalty (10% per month, up to 50%)
_______________________________
Interest (floating rate—see enclosed table)
_______________________________
TOTAL DUE
$
_______________________________
I hereby affirm under penalty of perjury that all of the above statements are true and correct to the best of my knowledge and belief.
Sworn and subscribed to before me this ______day of
, 20_____
________________________________________________________
________________________________________________________
Notary Public
Signature of Purchaser
_______________________________
_______________________________
Date
Date
THIS DOCUMENT MUST BE RETURNED TO THE DEPARTMENT OF REVENUE WITHIN 15 DAYS FROM RECEIPT. A COPY OF THE BILL OF
SALE AND OTHER DOCUMENTATION WHICH EVIDENCES OWNERSHIP AND ACTUAL SELLING PRICE MUST BE ATTACHED.
RETURN TO:
Department of Revenue
Enforcement Operations
Post Office Box 6417
Tallahassee, Florida 32314-6417

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