Form Dr 1369 - Colorado State Sales And Use Tax Exemption For Low-Emitting Heavy Vehicles Affidavit

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DR 1369 (01/14/13)
DR 1369 Web (01/14/13)
COLORADO DEPARTMENT OF REVENUE
COLORADO DEPARTMENT OF REVENUE
Denver, CO 80261
Denver, CO 80261
(303) 238-SERV (7378)
(303) 238-SERV (7378)
Colorado State Sales and Use Tax Exemption
For Low-Emitting Heavy Vehicles Affidavit
Motor vehicles greater than 10,000 pounds gross motor vehicle weight rating (GVWR) that are certified by the Federal Environmental
Protection Agency (EPA) or any state provided in the Federal Clean Air Act as meeting an emission standard equal to or more
stringent than the low-emitting vehicle (LEV) standard are exempt from Colorado state sales and use tax. [§39-26-719, C.R.S.]
Purchaser’s Name
Purchaser’s Telephone Number
(
)
Purchaser’s Address
City
State
ZIP
Vehicle Information
Vehicle Identification Number (VIN)
Year
Model
Make
Body Type
Date of Sale
The undersigned certifies that the referenced vehicle meets the requirements of §39-26-719, C.R.S., because the vehicle
is greater than 10,000 lbs. (GVWR) and is certified by EPA or a state as meeting a vehicle emissions standard that is
equal to or more stringent than the low emitting vehicle standard.
Dealer’s Name
Dealer’s Telephone Number
(
)
Dealer’s Address
City
State
ZIP
Dealer #
Dealer’s Sales Tax Account Number
Printed Name of Dealer Representative
Signature of Dealer Representative
Date
Unless cities, counties or special districts have adopted an ordinance or resolution to exempt LEV heavy vehicles, local taxes
are due on the purchase or sale of LEV heavy vehicles. Refer to Colorado Sales/Use Tax Rates (DR 1002) to determine if a
city or county has allowed this exemption. Home-rule cities are also listed in the DR 1002. Some home-rule cities enact their
own sales tax ordinances and collect their own taxes. Contact home-rule cities directly for their rules regarding sales taxes.
Purchaser must present form with Manufacturer’s Statement of Origin or title and proof of purchase at the time of
registration. Dealer must keep a copy of this form in their files.

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