Form Dr-123 - Affidavit For Partial Exemption Of Motor Vehicle Sold For Licensing In Another State
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1DR-123
Affidavit for Partial Exemption of Motor Vehicle Sold
R. 02/09
for Licensing in Another State
AffIDAvIT
State of Florida, County of ________________________________________
Before me, the undersigned Notary Public, personally appeared _____________________________________________________________ ,
Who, being duly sworn, says that he/she is a resident of the State of ___________________________________and that he/she is the
purchaser of the following described motor vehicle.
Name of Purchaser ____________________________________________________________________________________________________
State of Residence and
Address of Purchaser __________________________________________________________________________________________________
(Street)
(City)
(State)
(ZIP)
If the non-resident purchaser is a corporation or partnership, an officer or partner must acknowledge the following in order to be
allowed the partial exemption:
q The vehicle will be removed from this state within 45 days of purchase and will remain outside this state for a minimum of
180 days.
OR
If the vehicle is not removed from this state, an officer or partner in the non-resident corporation or partnership must certify the
following:
q There is no officer that is a resident of this state.
q There is no stockholder who owns at least 10% of the corporation that is a resident of this state.
q There is no partner in the partnership who has at least 10 percent ownership of the partnership that is a resident of this state.
Name of Seller ________________________________________________________________________________________________________
Address of Seller ______________________________________________________________________________________________________
(Street)
(City)
(State)
(ZIP)
Seller’s Sales Tax Registration Number ___________________________________________________________________________________
Date of Sale _____________________________________
Description of Motor Vehicle:
Make ___________________________________________Model __________________________________________Year __________________
vehicle Identification Number _______________________________________ Motor Number ______________________________________
Sales Price ________________________________________________________ Trade-In Allowance __________________________________
Sales Tax Paid to the StAtE of fLoRiDA $ _______________________________________
I, ___________ understand that I may owe sales tax to the State of _______________________________;
(Purchaser's Initials)
(Purchaser's state - Do Not Abbreviate)
• if the state, in which the vehicle is being registered/licensed, does not allow a credit for sales tax paid to the State of Florida; or
• if that state imposes a rate higher than 6 percent.
I also understand;
• sales tax is being paid to Florida and not to any other state; and
• I may request a copy of the "Motor vehicle Sales Tax Rates by State" from the above motor vehicle dealer or the florida
Department of Revenue.
This vehicle will be licensed in the State of ___________________________ within forty-five (45) days after the date it was purchased in
the State of Florida.
Sworn to (or affirmed) and subscribed before me this _____________ day of __________, A.D., _________.
(Day of Month)
(Month)
(Year)
______________________________________________
___________________________________________
(Signature of Nonresident Purchaser)
(Signature of Notary)
Personally Known _________________________
Or Produced Identification _________________________
______________________________________________________
Type of Identification Produced _________________________
Print, Type or Stamp Name of Notary
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