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Form Gt-500003 - Suggested Format For Affidavit For Exemption Of Boat Sold For Removal From The State Of Florida By A Nonresident Purchaser Page 2

DESCRIPTION OF BOAT

Make _________________________ Model ______________________ Year __________________________

Hull Number ___________________________________________

New

Used

Name of Vessel (New) _____________________________________ (Ex) ______________________________________________

State/County Registration and/or Coast Guard Documentation Number __________________________________________________

Sales Price _______________________________________ Trade-In Allowance _________________________________________

Net Amount Paid ______________________________________

Ninety Day Decal Number, if applicable (Affix Here): _______________________________________________________________

Primary Location of the Vessel Prior to Removal: ___________________________________________________________________

__________________________________________________________________________________________________________

Under the penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true to the

best of my knowledge and belief. I understand that if I fail to comply with the requirements of this affidavit I

will be liable for payment of the tax and a mandatory penalty equal to the tax. I further understand that if I

purchase a decal and remove or alter it, or cause or allow another person to do the same, then I will be

subject to payment of the tax plus a 200 percent penalty. I further understand that I may be subject to

imprisonment of up to 1 year and a fine of up to $1000.00.

_______________________________

Signature of Affiant (Purchaser)

Sworn to (or affirmed) and subscribed before me this ____ day of ______________ , _________ .

Signature of Notary

Print, Type or Stamp Name of Notary

Personally known

Produced identification

Type of Identification: _______________________________

Original and copy of invoice, bill of sale or closing statement must be submitted within five (5) days of the date of sale to the Florida

Department of Revenue, Central Compliance and Enforcement, Boat Enforcement Unit, P.O. Box 6417, Tallahassee, Florida

32314-6417.

1st copy: To be retained by the dealer and made part of the dealer’s records

2nd copy: Purchaser’s copy

Dealer’s Notice: Affidavits not filed within five (5) days of the date of sale or closing will not be accepted by the Florida Department

of Revenue.

Form Gt-500003 - Suggested Format For Affidavit For Exemption Of Boat Sold For Removal From The State Of Florida By A Nonresident Purchaser Page 2