Form Dr 1369 - Colorado State Sales And Use Tax Exemption For Low-Emitting Heavy Vehicles Affidavit
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1DR 1369 (10/18/13)
*141369==19999*
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261-0009
(303) 238-SERV (7378)
Colorado State Sales and Use
Tax Exemption For Low-Emitting Heavy Vehicles Affidavit
Motor vehicles greater than 10,000 pounds gross motor vehicle weight rating (GVWR) that are certified by the Federal
Environmental Protection Agency(EPA) or any state provided in the Federal Clean Air Act as meeting an emission standard
equal to or more stringent than the low-emitting vehicle (LEV) standard are exempt from Colorado state sales and use tax.
[§39-26-719, C.R.S.]
Purchaser’s Last Name
First Name
Middle Initial Phone Number
(
)
Purchaser’s Address
City
State
Zip
Vehicle Information
Year
Model
Make
Body Type
Vehicle Identification Number (VIN) Date of Sale
(YYYY)
(MM/DD/YY)
The undersigned certifies that the referenced vehicle meets the requirements of §39-26-719, C.R.S., because the
vehicle is greater than 10,000 lbs. (GVWR) and is certified by EPA or a state as meeting a vehicle emissions standard
that is equal to or more stringent than the low emitting vehicle standard.
Dealer’s Last Name
Dealer’s First Name
Middle Initial Dealer’s Phone Number
(
)
Dealer’s Address
City
State
Zip
Dealer’s Number
Dealer’s Sales Tax Account Number
(
)
Printed Name of Dealer Representative
Signature of Dealer Representative
Date
(MM/DD/YY)
Unless cities, counties or special districts have adopted an ordinance or resolution to exempt LEV heavy vehicles, local
taxes are due on the purchase or sale of LEV heavy vehicles. Refer to Colorado Sales/Use Tax Rates (DR 1002) to
determine if a city or county has allowed this exemption. Home-rule cities are also listed in the DR 1002. Some home-rule
cities enact their own sales tax ordinances and collect their own taxes. Contact home-rule cities directly for their rules
regarding sales taxes. Purchaser must present form with Manufacturer’s Statement of Origin or title and proof of purchase
at the time of registration. Dealer must keep a copy of this form in their files.
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