KANSAS DEPARTMENT OF REVENUE
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SALES TAX EXEMPTION CERTIFICATE
Date __________________ County _____________________________
Purchaser: _________________________________________
Purchased from: ___________________________________
Address: ___________________________________________
Address: ___________________________________________
City, State, Zip: ____________________________________
City, State, Zip: ____________________________________
Telephone No. ______________________________________
Telephone No. ______________________________________
Make ____________________________ Year _____________ I.D. No. _____________________________________
Type:
Auto
Truck
Tractor
Trailer
Cycle
Other ____________
Purchase Price: $ _______________________
Purchased from a retailer not in possession of form STD
Purchased as rolling stock by common carrier for use
8. Sales tax registration number ______________________
in interstate commerce.
Tax paid to the above retailer $ _______________________
I.C.C. Common Carrier No. ___________________________
(attach copy of invoice)
K.C.C. Interstate Common Carrier No. ________________
Purchased for rental or lease. Sales tax registration
Transfer of all assets of one corporation to another
number ______________________________________________
corporation.
Purchased and used in another state. Vehicle was regis-
Transfer by a person to a corporation solely in exchange
tered in the name of _________________________________
for stock or securities in such corporation.
________________________________________ in the state of
Gift. No consideration. Explanation: __________________
______________________________ for the year __________ .
______________________________________________________
Purchased by the State of Kansas or a political subdivi-
______________________________________________________
sion thereof. Name of political subdivision department.
Even exchange of vehicles — make, model and year of
_____________________________________________________
vehicle traded. _______________________________________
Purchased by nonprofit hospital, educational institution
______________________________________________________
or public or private elementary or secondary school.
Exemption claimed for another reason. Fully explain.
Name of institution. __________________________________
______________________________________________________
Purchased for resale. Sales tax registration number
______________________________________________________
___________________ . Dealer number __________________
______________________________________________________
Kansas Administrative Regulation 92-19-30 states in part:
“Burden is on transferee to prove exemption, affidavit required. The transferee claiming an exemption must file an affidavit with the
director of revenue or the county treasurer stating the name, address, and telephone number of the transferer; the name, address, and
telephone number of the transferee; the make, year and style of the motor vehicle or trailer; and such other information as the director
of revenue may require.
It is also mandatory that the affidavit contain facts in detail sufficient to clearly bring the transferee within the exemption claimed. For
example, if he claims the transfer was a gift from a person in the close family relationship as set out above, the transferee must state his
relationship to the transferer and also state that no money was given in exchange.
Affidavits of exemption which are not correct in both substance and form cannot be accepted by the director of revenue in lieu of the
tax.
In case of doubt, the county treasurer shall collect the tax. It is always the privilege of the taxpayer to file a claim with the director of
revenue for refund if he believes the tax has been erroneously collected.
Criminal prosecution for false affidavit. Persons who make false affidavits under this regulation do so at their peril, subject to severe
pains and penalties of perjury, and they will be prosecuted to the full extent of the law. The director of revenue will request the attorney
general of the state of Kansas as well as any county attorney to assist in such prosecution.”
This is to certify that I purchased the above described motor vehicle or trailer which is except from the payment of Kansas
retailers’ sales tax for the reason stated above.
The undersigned understands and agrees that if the Department of Revenue determines the purchase of this vehicle is not
exempt from the tax, the purchaser becomes liable for the tax.
Purchaser’s
County Treasurer’s
Signature ________________________________________________
Signature ________________________________________________
Witness
STD 8E
PS-1642
(Rev. 05/81)