Form Dr-99a - Affidavit For Private Casual Sale Of A Motor Vehicle
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1DR-99A
R. 05/99
Affidavit for Private Casual Sale of a Motor Vehicle
Warning: Section 212.05(1)(a)1.b., F.S. provides in part: “. . . Any party to such sale who reports a sales price less than the actual sales
price is guilty of a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. The department shall collect . .
. from such party any delinquent sales taxes. In addition, such party shall pay any tax due and any penalty and interest assessed plus a
penalty equal to twice the amount of additional tax owed. . . . ”
Seller’s Affidavit
STATE OF _____________________________________________________ COUNTY OF ______________________________________________________
Before me this day personally appeared _______________________________________________________ , who being first duly sworn, deposes and says: As
seller of the vehicle described as a
_________________________________________________________________________________________________________________________________
(MAKE)
(MODEL)
(VEHICLE IDENTIFICATION NUMBER)
I swear or affirm that the total selling price of said vehicle, including any unpaid balance due, was $ _____________________.
I understand that giving a false statement can subject me to penalty equal to twice the amount of the additional tax owed.
Sworn to (or affirmed) and subscribed before me this _____________ day of __________, A.D., _________.
(Day of Month)
(Month)
(Year)
______________________________________________
_______________________________________________
(Signature of Seller/Affiant)
(Signature of Notary)
Personally Known ______________________
_______________________________________________
Or Produced Identification _______________________
Type of Identification Produced ______________________
Print, Type or Stamp Name of Notary
Purchaser’s Affidavit
STATE OF _____________________________________________________ COUNTY OF ______________________________________________________
Before me this day personally appeared _______________________________________________________ , who being first duly sworn, deposes and says: As
purchaser of the vehicle described as a
_________________________________________________________________________________________________________________________________
(MAKE)
(MODEL)
(VEHICLE IDENTIFICATION NUMBER)
I swear or affirm that the total purchase price of said vehicle, including any unpaid balance due, was $ _____________________.
I understand that giving a false statement can subject me to penalty equal to twice the amount of the additional tax owed.
Sworn to (or affirmed) and subscribed before me this _____________ day of __________, A.D., _________.
(Day of Month)
(Month)
(Year)
This transaction
______________________________________________
_______________________________________________
is subject to
(Signature of Purchaser/Affiant)
(Signature of Notary)
review by the
Department of
Personally Known ______________________
Revenue
_______________________________________________
Or Produced Identification _______________________
Type of Identification Produced ______________________
Print, Type or Stamp Name of Notary
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