Form Ut-11c - County Vehicle Use Tax Exemption Certificate

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COUNTY VEHICLE USE TAX EXEMPTION CERTIFICATE
dmv.ny.gov
As the registrant, I certify that the vehicle described below is not subject to a county use tax for the following reason
(check one):
o
A. I am not a legal resident of ____________________________________ County. I reside in
_________________________________ County.
o
B. The vehicle is owned by a non-profit religious, charitable or educational organization that is exempt
from the tax, as determined by the NYS Department of Taxation and Finance.
The tax exemption number is ___________________________.
o
C. The vehicle is used only in connection with the operation of a farm by the owner or tenant of the farm.
I understand that this certification will be forwarded to the appropriate county for review, and that if I falsely state
that this vehicle qualifies for exemption, I may be subject to punishment under Section 210.45 of the Penal Law, and
that I may have to pay penalties and interest as provided by law.
Name of Registrant (Please Print)
Plate Number
Year of Vehicle
Make of Vehicle
Street
City
State
Zip Code
County
Sign Name in Full
Date
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reset/clear
UT-11C (4/16)

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