Motor Vehicle Excise Tax Refund Application Form printable pdf download

Motor Vehicle Excise Tax Refund Application Form

MOTOR VEHICLE EXCISE TAX REFUND APPLICATION FORM

Please fill out this form as completely as possible. The form does not need to be fully completed to be considered

by the Department of Revenue. Please type or print neatly. Attach additional pages if necessary.

I am an enrolled member of the

Tribe.

Name:

Enrollment number:

I am applying for a refund of motor vehicle excise tax for the following motor vehicle:

Make:

Model:

Vehicle Identification Number:

Year:

Title Number:

Date of Purchase of Motor Vehicle:

Check the items below applicable to your claim:

When I paid the motor vehicle excise tax on the above vehicle, I resided in:

Corson County ( ) Dewey County ( ) Shannon County ( ) Todd County ( ) Ziebach County ( ) OTHER ( )

If you checked “OTHER” above, state the county and the legal description or physical location of the property

where you resided when you paid the motor vehicle excise tax for the vehicle described above:

When I paid the motor vehicle excise tax on the above vehicle, to the best of my knowledge, I was a tribal member

residing in Indian country governed by my tribe. Yes ( ) No ( )

List all names and spellings under which you may have registered a motor vehicle, including “Jr.” or “Sr.”:

(1)

(2)

(3)

(4)

By signing this form I hereby certify that the answers above are correct. I further certify that by the signing and

submitting of this form I authorize the release of my tribal enrollment information to the Department of Revenue.

Applicant’s Signature

Current Address:

Current Telephone Number:

Send Form To:

South Dakota Department of Revenue

Note: Motor Vehicle Tax Refund Application

445 East Capitol

Pierre, South Dakota 57501-3100

SEND ONLY ONE FORM FOR EACH VEHICLE

Motor Vehicle Excise Tax Refund Application Form