Form Rev 32 0047e - Non-Resident Vessel Repair Affidavit

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Washington State
Department of Revenue
Compliance Administration
Non-Resident Vessel Repair Affidavit
PO Box 47473
Olympia WA 98504-7473
(RCW 88.02.570)
State of Washington
County of
being first duly sworn on oath, deposes and says:
(Owner/Operator)
(Phone Number)
that I am a bona fide resident of the state of
date of birth
and
that my address is:
(Address)
(City)
(State)
(Zip Code)
I brought into Washington the following described vessel, to-wit:
that on the
day of
Make
Model
Year
Hull Identification Number
Name
Documentation Number
Home Port
State Registration Number
Moored at
and that said vessel is exclusively undergoing repair or
reconstruction by
(Business Name)
(UBI/Tax Registration No.)
located at
(Address)
(City)
(Phone Number)
for a period not to exceed sixty (60) days. Expiration date being the
day of
(Day)
(Month)
(Year)
For extensions, contact the Department of Revenue prior to expiration.
Dated at
Washington, this
day of
(Day)
(Month)
(Year)
(Signature of Vessel Owner)
Subject to Audit
or
Not Valid Until Approved
by the Department of Revenue
(Signature of Vessel Operator)
Subscribed and sworn to before me this
day of
(Day)
(Month)
(Year)
NOTARY PUBLIC IN AND FOR THE STATE OF WASHINGTON
RESIDING AT
For tax assistance or to request this document in an alternate format, visit or call 1-800-647-7706. Teletype (TTY) users
may call (360) 705-6718.
REV 32 0047e (05/14/12)
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