Form 51a280 (7-13) - Out-Of-State Purchase-Use Tax Affidavit

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OUT-OF-STATE PURCHASE–USE TAX AFFIDAVIT
51A280 (7-13)
Commonwealth of Kentucky
(Document for use by taxpayers purchasing tangible property
DEPARTMENT OF REVENUE
from out–of–state for title or first–time registration)
TO BE COMPLETED BY TAXPAYER
Property Information
 
Type: (Check one)
Trailer
Boat
Manufactured Home
ATV
 
 
 
      
      
     
   
 
Other (describe) __________________________________________________
Year ____________________ Make ______________________________
Model ______________________________
VIN (if applicable) _____________________________ Title (if applicable) ______________________________
Purchaser’s Information
Name of Purchaser (Print)
Signature
KY Driver’s License #
Address of Purchaser
Seller’s Information
Name of Seller (Print)
Date of Sale
Sales Price (Attach Documentation)
Address of Seller
Notary Information
Attesting Official
Title
Subscribed and sworn to before me this __________ day of ______________________________, 20 ____.
My commission expires ___________________________________________________________________.
Note to Taxpayer: Retain a copy of this form, along with your registration receipt document, for proof of use tax paid, or exemption claimed.
TO BE COMPLETED BY COUNTY CLERK
County _________________________
Use Tax Collected $____________________
s not collected, check one of the following:
If use tax i
 Code U1 (Occasional Sale) —KRS 139.010(15)
 Code U2 (Resale Certificate)—Attach Form 51A105.
 Code U3 (Purchase Exemption)—Attach completed Form 51A126.
 Code U4 (Agricultural Exemption)—Attach completed Form 51A158.
 Code U5 (Fifth Wheel Trailer)—KRS 139.470(21)–Trailer mounted in a truck bed and designed for carrying freight
> 1,000 lbs.; does not include bumper hitch trailers.
If a use tax credit was given, check one of the following:
 Code U8 (Credit for sales tax paid to another state)—Attach copy of receipt.
 Code UC (Credit for Kentucky use tax previously reported and paid)—Attach copy of receipt.
Note to County Clerk: Any and all sales and use tax documents associated with the above transactions must be attached and submitted to the
Motor Vehicle Usage Tax Section, bundled separately from other usage tax documents currently supplied.
COPY DISTRIBUTION:
WHITE—Department of Revenue
CANARY—County Clerk
PINK—Taxpayer

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