Commercial Vessel Seller'S Report Of Sale
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1State of Washington
Commercial Vessel Seller’s
Department of Revenue
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Special Programs Division
Miscellaneous Tax
Report of Sale
PO Box 47477
Olympia WA 98504-7477
DOR Use Only
UBI No:
CVT No:
OID No:
Close Date:
Listing Sent:
Yes
No
N.O.V. Sent:
Yes
No
A. Seller Information
Seller’s Name
(Last)
(First)
( Middle)
Home Phone
Home Address
(Street or Route, PO Box)
Business Phone
(City)
(State)
(Zip Code)
B. Purchaser Information
Purchaser’s Name (Last)
(First)
( Middle)
Home Phone
Home Address
(Street or Route, PO Box)
Business Phone
(City)
(State)
(Zip Code)
C. Vessel Information
Vessel Name
UBI No.
Commercial Vessel Tax No.
Document No.
Make/Model
Owner Identification No.
Department of Licensing No.
Year Built
Department of Fish and Wildlife Vessel Registration No.
Length
WN No.
Hull Identification No.
D. Sale Information
Purchase Price Detail:
Ship or Vessel Price: $
Date of Sale:
Motor/Price: $
Broker:
Accessories/Price: $
0.00
Total Purchase Price: $
Title/Documentation Service:
(Exclude Fees, Licenses, Taxes)
E. Vessel Use Type
After sale, did vessel leave the state permanently?
Yes
No
After sale, was vessel converted to personal use and watercraft excise tax paid?
Yes
No
After sale, is vessel to continue commercial service in Washington?
Yes
No
F. Signature
The undersigned hereby states, to the best of their knowledge, that the above information is true and correct.
(Print Name)
(Signature)
(Date)
For tax assistance or to request this document in an alternate format, visit or call 1-800-647-7706. Teletype
(TTY) users may call (360) 705-6718.
REV 87 1006e (8/10/10)
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