Form Rev 87 1001a - Commercial Vessel Tax Notice Of Value
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1
2State of Washington
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Department of Revenue
Special Programs Division
COMMERCIAL VESSEL TAX
Miscellaneous Tax
PO Box 47477
NOTICE OF VALUE
Olympia WA 98504-7477
Please make any corrections to the address printed below.
IMPORTANT: RETURN BY FEBRUARY 20, 2012
DOR Tax Registration No:
Vessel Name:
Name: ____________________________________________
CVT No.:
Owner ID No.:
Address:
________________________________________
Document or WN No.:
Assessment Year:
________________________________________
Valuation:
________________________________________
The Department of Revenue
will collect the tax in: 2013
1 (a).
Is the vessel used for interstate or foreign commerce?
Yes
No
A ship or vessel is engaged in interstate or foreign commerce when transporting persons or property for hire from one state or
territory of the United States to another, or between a state or territory of the United States and a foreign country.
(b).
Is this vessel used exclusively in fishing, tendering, harvesting and/or processing seafood products on the high seas or
waters under the jurisdiction of other states?
Yes
No
I
(1a)
(1b)
,
2. I
,
3.
F YOU ANSWERED YES TO SECTION
OR
ABOVE
COMPLETE SECTION
F NOT
SKIP TO SECTION
2. Apportionment: (See rules on reverse side)
Year
Number of Days
Vessel was out of state
2011
Vessel was in state exclusively for repairs
2011
Vessel was in state in service, moored or other
2011
0
TOTAL DAYS (Must equal 365 days)
3. Added Value: If you added value to this vessel during the past year, specify the amount of value added and attach a copy of the
receipt(s) or a list of the items added. $
4. Change of Ownership: (Provide a copy of the Purchase/Sale Agreement or Bill of Sale)
New Owner:
Sale Price:
Address:
Date of Change:
City, State, Zip:
Phone No.:
5. Destruction: If the subject vessel was destroyed, please state the date of destruction: ________________________, and attach
documentary evidence regarding the vessel’s destruction.
Information provided on this notice is subject to audit by the Department of Revenue. I certify under penalty of perjury under
the laws of the State of Washington that the foregoing is true and correct .
Print Your Name
Signature
Date
City
Phone Number
REV 87 1001A (2/1/12)
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