Arizona Form 5010q - Sale Of Motor Vehicle To Nonresident For Use Outside Of State - Certificate Of Delivery Out Of State

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ARIZONA DEPARTMENT OF REVENUE
ARIZONA FORM
SALE OF MOTOR VEHICLE TO NONRESIDENT FOR USE OUTSIDE OF STATE
5010Q
CERTIFICATE OF DELIVERY OUT OF STATE
This form is to be used as a cover sheet for the quarterly submission of copies of Form 5010 certifi cates that have been
accepted by the motor vehicle dealer. (Both sides of the certifi cate must be submitted.) This form and the submitted copies
of the certifi cates will be treated as confi dential information supplied to the Department. Please remit this completed form
and certifi cate copies to:
ARIZONA DEPARTMENT OF REVENUE
NONRESIDENT CAR PROGRAM - TPT AUDIT DIVISION
1600 W. MONROE, SUITE 620
PHOENIX AZ 85007
Business / Dealer Information
Business / Dealer Information
Business Name:
TPT License #:
Mailing address
City
State
Zip Code
Business phone (Include area code)
Sales of: (Check all that apply:)
Motor Vehicles
All
Other
Recreational Vehicles
Motorcycles
Vehicle / Purchaser Information
Vehicle / Purchaser Information
Year/Make/Model
Vehicle Identifi cation Number(VIN):
Purchaser Name & Driver’s License #:
ADOT 30-Day Reg #:
Total Certifi cate Copies attached:
Total Certifi cate Copies attached:
Number of continuation pages attached:
Number of continuation pages attached:
Taxpayer’s Signature
Title
Date
ADOR 60-5415 (6/07)

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