Form Md-1 - Military Sales Tax Deferment Application Page 2
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2MD-1 (01/12)
________________________________________________________________________
NAME:
LAST
FIRST
MI
__________ - __________ - __________
SOCIAL SECURITY NUMBER:
CURRENT MAILING ADDRESS:
ADDRESS /CITY, STATE, ZIP CODE
________________________________________________________
CURRENT PHONE NUMBER:
________________________________________________________
CURRENT EMAIL ADDRESS:
NAME AND ADDRESS OF DUTY STATION:
ADDRESS /CITY, STATE, ZIP CODE
VEHICLE INFORMATION:
YEAR
MAKE
MODEL
BODY TYPE
SERIAL NUMBER
_____________________________________________________
DEALER NAME:
_____________________________________________________
ADDRESS :
______________________________________
PURCHASE DATE:
______________________________________
PURCHASE PRICE:
I SWEAR UNDER THE PENALTIES OF PERJURY AND FALSE SWEARING THAT ALL OF THE INFORMATION ON THIS
APPLICATION ARE TRUE AND I WILL PAY THE NEW JERSEY SALES TAX DUE UPON THE FIRST USE OF THE VEHICLE
IN NEW JERSEY BASED ON ITS VALUE AT THAT TIME.
APPLICANTS SIGNATURE
DATE
NOTARY SEAL
New Jersey Is An Equal Opportunity Employer • Printed on Recyclable Paper
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