R-1382 (9/09)
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out-of-state Purchasers of off-road vehicles
sales tax affidavit and exemption certificate
Louisiana R.S.47:305.56
Louisiana Department of Revenue
Office Audit Division, Motor Vehicle Section
P.O. Box 66783
Baton Rouge, LA 70896-6783
Telephone: (225) 219-2438
Please Print or tyPe.
Vehicle Model
Vehicle Year
Vehicle Make
Vehicle Identification Number
Sales Invoice Number
Sales Price
Seller Dealership Name
Telephone Number
Location Address
City
State
ZIP
the Purchaser certifies the following:
•
The purchaser is domiciled in
and a copy of the proof of residency is attached.
name of state
•
.
The purchaser’s state of domicile provides a similar exemption. (Currently only Mississippi, Oklahoma and Tennessee)
affidavit of tax Payment
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The purchaser declares that this off-road vehicle will be brought or delivered to the purchaser’s state of domicile, that it will not be
used in Louisiana, and that the purchaser will pay the proper sales tax to his state of domicile within 60 days of the date of purchase
or delivery, whichever is later.
•
The purchaser understands that this exemption does not apply to local sales tax and failure to pay the sales tax to his state of
domicile within the time allowed could result in an assessment for the Louisiana state sales tax.
•
The purchaser understands that a copy of this exemption certificate and affidavit will be provided to the purchaser’s state of domicile
to ensure payment of the tax.
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The purchaser understands that making a false sworn statement is subject to state and federal statutes and may be punishable by
fines and/or imprisonment.
certification of Purchaser
Print Purchaser’s Name
Purchaser’s Signature
Date
(mm/dd/yyyy)
x
Location Address (P.o. Box not accePted)
Telephone Number
City
State
ZIP
Print Witness’s Name
Witness’s Signature
Date
(mm/dd/yyyy)
x
notice to dealers: Louisiana residents are not eligible for this exemption. To ensure that the sales tax is properly paid to the purchaser’s state of
domicile, dealers are required to submit copies of all exemption certificate affidavits and residency documentation to the Louisiana Department
of Revenue, Office Audit Division, Motor Vehicle Section, Post Office Box 66783, Baton Rouge, Louisiana 70896-6783, each month in which
an exemption certificate affidavit was accepted. If the dealer has questions or needs to verify if a purchaser’s state of domicile provides a similar
exemption and therefore qualifies for the Louisiana sales tax exemption, contact the Office Audit Division at (225) 219 -2438.
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