Form Ae-4 - Aircraft Purchaser'S Affidavit For Retail Sales Tax Exemption
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1AE-4
Indiana Department of Revenue
State Form 7669
Aircraft Purchaser’s Affi davit for
(R6 / 4-13)
Retail Sales Tax Exemption
For assistance, call (317) 615-2544.
This form should be retained by the seller.
Seller (including provider of completion work):
Name (Last, First, Middle Initial)
Street Address
City
State
Zip Code
Purchaser (including purchaser of completion work):
Name (Last, First, Middle Initial)
Street Address
City
State
Zip Code
State/Country of Residency of Purchaser
State/Country of Title, Registration, or Base of Aircraft
Description of Aircraft:
FAA Number
Year of Mfg.
Serial Number
Date of Purchase
(Month, Day, Year)
N
Aircraft Make
Aircraft Model
I hereby affi rm under penalty of perjury and as required under IC 6-2.5-5-42, the following elements exist for this transaction:
The purchaser is a nonresident of Indiana, and the purchaser will transport the aircraft to a destination outside Indiana within thirty (30)
days after: accepting delivery of the aircraft; a repair, refurbishment, or remanufacture of the aircraft is completed, if the aircraft remains in
Indiana after the purchaser accepts delivery for the purpose of accomplishing the repair, refurbishment, or remanufacture of the aircraft;
or accepting delivery (as defi ned in IC 6-2.5-3-2(f)) of the aircraft following completion work or a pre-purchase evaluation (as defi ned in
IC 6-2.5-3-2(f)).
The aircraft is or will be titled or registered in another state or country is or will be based (as defi ned in IC 6-6-6.5-1(m)) in that state or
county, if a state or country does not require a title or registration for aircraft; and the aircraft will not be titled or registered in Indiana.
Date (Month, Day, Year) _______________________
Signature of Purchaser ________________________________________
Printed Name of Purchaser _____________________________________
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