Form Ae-5 - Aircraft Purchaser'S Affi Davit For Proof Of Purchase Price

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Indiana Department of Revenue
AE-5
State Form 55255
Aircraft Purchaser’s Affi davit for Proof of Purchase Price
(4-13)
• Due at time of Application for Registration
• For assistance call (317) 615-2544
• Mail to: Indiana Department of Revenue
Special Tax-Aeronautics
P.O. Box 644
Indianapolis, Indiana 46206-0644
SELLER:
Name (Last, First, Middle Initial)
Street Address
City
State
Zip Code
PURCHASER:
Name (Last, First, Middle Initial)
Street Address
City
State
Zip Code
DESCRIPTION OF AIRCRAFT PURCHASE:
FAA Number
Year of Mfg.
Serial Number
Date of Purchase
(Month, Day, Year)
N
Aircraft Make
Aircraft Model
DESCRIPTION OF TRADE (must be an aircraft or aircraft parts):
FAA Number
Year of Mfg.
Serial Number
N
Aircraft Make
Aircraft Model
SUMMARY:
Aircraft Selling Price
$
Subtract Aircraft Trade Value
$
Amount Subject to Sales/Use Tax
$
I hereby verify, under penalty of perjury, that the total price paid for the above described aircraft represents the true amount collected for
the sale of the aircraft. This statement is made for the purpose of providing a value for use by the Indiana Department of Revenue in
determining the purchaser’s Sales/Use Tax. See IC 6-6-6.5-17.
Date (Month, Day, Year) _______________________
Signature of Seller ____________________________________________
Print Name of Seller ___________________________________________

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