Antique Automobile Application Form - Burke County, North Carolina
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1Daniel Isenhour
Tax Administrator
P O Box 219
Burke County
Morganton, NC 28680
(828)764-9430
Office of Tax Administration
tax@co.burke.nc.us
ANTIQUE AUTOMOBILE APPLICATION
Name: ________________________________
Account Number: __________
Address: ____________________________
Record Number: ___________
____________________________
Phone # ______________________
Year: ______________________
Make: ______________________
Model: ____________________
VIN: ________________________
Tag #: _____________________
Odometer Reading: ______________
Date of Reading: _____________________
In accordance with NCGS 105-330.9 “antique automobile” means a motor vehicle that meets
all of the conditions in this statute.
•
Registered with NCDMV and has a special license plate (GS20-79.4(63)).
•
Maintained primarily for exhibitions, club activities, parades, other public functions.
•
Used only occasionally for other purposes.
•
Owned by an individual.
•
Is not used to produce income or for business purposes.
PLEASE COMPLETE THE FOLLOWING QUESTIONS
What is the primary use of this vehicle?
Is this vehicle used in car shows, parades, or similar activities? Yes ____
No _____
What was the last activity it was in? ______________________________________
Date of the Activity: ___________________
Was it driven to the activity? Yes ____ No _____
Estimate the number of such activities this vehicle has attended in the last year.____
How often and for what other reasons is this vehicle driven?
How many miles has this vehicle been driven in the last year? __________________
Is this vehicle used in connection for any income producing purposes or business activities?
Yes ____ No _____
AFFIDAVIT
I, the undersigned, do hereby certify that the odometer reading I have listed below is correct and
all questions have been answered true full. It will only be used in connection with assessing
and taxation for tax purposes only.
TAX OFFICE USE ONLY
________________________
____________________
(Owner’s Signature)
(Date filed)
_________________________
______________________________
)
(Received By
Approved: YES_____ NO ______
(Date)
________________________
(Date)
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