Form 6xn - Amended Nebraska Sales/use Tax And Tire Fee Statement
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1Every person who sells a motor vehicle should complete and give it to the purchaser of the motor vehicle. This form can
be obtained by contacting the Department or the county treasurer in which the motor vehicle will be registered.
FORM
AMENDED NEBRASKA SALES/USE TAX AND TIRE FEE STATEMENT
6XN
for Motor Vehicle and Trailer Sales
Purchaser’s Name and Address
Seller’s Name and Address
Name
Name
Address
Address
City
State
Zip Code
City
State
Zip Code
Vehicle Make
Model Year
Body Type
Vehicle ID Number (VIN)
Purchase Date
County in Which Original Form 6 Was Filed
Date Original Form 6 Was Filed
Amended (A)
Original (B)
Difference (C)
$
$
1 Total Sale Price . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
2 Trade-in Allowance . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3 Less Manufacturer’s Rebate . . . . . . . . . . . . . . . . . . . . . .
3
$
4 Sales Tax Base . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
5 State Sales/Use Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5
6 Local Sales/Use Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6
7 Number of Tires
x $1.00 . . . . . . . . . . . . . . . . . . .
7
$
$
$
8 Total Tax and Tire Fee . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
$
9 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
10 Penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
$
11 Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Under penalties of law, I declare that I have examined this statement and, to the best of my knowledge and belief, it is
correct and complete.
sign
here
Signature of Purchaser
Date
Instructions
on the unpaid tax and fee due at the statutory rate from the thirtieth
Who May File. Any person wanting to change their original
day after the purchase until the date of payment.
Nebraska Sales/Use Tax and Tire Fee Statement for Motor Vehicle
and Trailer Sales, Form 6, may file this form. Form 6XN is to be
Specific Instructions
completed only if additional sales and use tax or tire fee is due.
Column A. Complete this column by entering the corrected figures.
Reference should be made to the original Form 6 in completing
Form 6XN.
Column B. Complete this column by entering the figures as originally
reported on Form 6.
If you need information about requesting a refund of sales and
use tax or tire fee, contact the Nebraska Department of Revenue
Column C. Complete this column by entering the difference between
at 800-742-7474 (NE and IA), or 402-471-5729.
the corrected figures and the original figures. For each line, subtract
Column B from Column A.
When and Where to File. Form 6XN may be filed at any time after
you have filed your original Form 6. This amended form, properly
Line 8, Column C is the additional tax and fee due. Interest will be
signed and accompanied by remittance, is to be filed with the county
computed by the county treasurer or the Department of Revenue. The
treasurer in the county where the original form was filed or with the
total tax, tire fee, interest, and penalty must be remitted to the county
Nebraska Department of Revenue.
treasurer or to the Department of Revenue. If Form 6XN is issued
to the county treasurer, the county treasurer will maintain the white
Penalty and Interest. A penalty will be assessed in the amount of
copy of this form and provide a copy to the Department upon request.
$5 in addition to the amount of tax or fee due. Interest will be assessed
TAXPAYER — Canary Copy
DEPARTMENT OF REVENUE OR COUNTY TREASURER — White Copy
6-2013
6-163-1975 Rev.
Supersedes 6-163-1975 Rev. 11-2008
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