Form Ae-3 - Annual Report Of Exempt Aircraft Used In Public Transportation
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1AE-3
Indiana Department of Revenue
Mail To: Indiana Department of Revenue
Special Tax – Aeronautics
Annual Report of Exempt Aircraft Used in Public Transportation
State Form 54086
P.O. Box 644
(R4 / 4-13)
Indianapolis, IN 46206-0644
Required by IC 6-2.5-5-8(h)
Telephone (317) 615-2544
Fax (317) 615-2691
Due annually 30 days after the end of the month in which
the aircraft was originally placed in service for leasing.
FAA N Number
Aircraft Serial Number
Base Airport
Registered Owner of Aircraft
Name
Federal ID Number / Indiana Taxpayer ID Number
Telephone Number
Street Address
City
State
ZIP Code
A copy of the your FAA 135 Certifi cation, operating specifi cations, federal excise due and proof of payment are required documentation and must be submitted with the report or the
exemption may be denied resulting in sales/use tax due on the purchase price.
Aircraft Leased to:
Name
Federal ID Number / Indiana Taxpayer ID Number
Street Address
Telephone Number
City
State
ZIP Code
Date of Use
Total Hours Flown
Type of Flight Part 135 or Part 91
Amount of Federal Excise Tax Collected & Remitted
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
□
□
Part 135
Part 91
$
Total Hours Flown
Total Hours Flown Part 91
Total Hours Flown Part 135
Percentage of Public Transporation Use
%
I certify under the penalties of perjury that all of this information is true and correct to the best of my knowledge.
Signature of Authorized Person
Date
Printed Name of Authorized Person
Title
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