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Maine Affidavit of Exemption Form

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Maine Affidavit of Exemption Form
Maine Affidavit of Exemption Form
MAINE REVENUE SERVICES
SALES/EXCISE TAX DIVISION
The undersigned hereby certifies that the item described below is sold exempt from Maine sales tax because it was
delivered to the purchaser outside the State of Maine by contract or common carrier or by the seller.
Type of Property ______________________________________________________________________________
mobile home, motor vehicle, boat, etc.
Make____________________________ Year__________________ Model No. ____________________________
Serial No.___________________ Sales Price $______________________ Trade in $_______________________
Date of Sale______________________________ Date of Delivery_______________________________________
The property described above was delivered to: Name of Purchaser_______________________________________
Legal Address of Purchaser______________________________________________________________________
Street City State
Place of Delivery * ____________________________________________________________________________
Street City State
I hereby authorize Maine Revenue Services to furnish a copy of this affidavit to the state in which the purchaser
declares herein as his legal address and/or to the state in which delivery was made.
Name of Seller_____________________________________ Sales Tax Cert. No.___________________________
Address______________________________________________________________________________________
Signature of Seller _____________________________________________________________________________
Signature of Person Making Delivery ______________________________________________________________
The person shown above as seller or making delivery _________________________________________________
Name of person
personally came to me, who being duly sworn, did depose and say that the statements contained herein are true and
correct.
Signed:______________________________________ _________________________________________
Justice of the Peace-Notary Public
Date: ______________________________________
My commission expires:_______________________
INSTRUCTIONS: This form, when completed, is to be forwarded by the dealer to the Sales Tax Section with the dealer's monthly sales tax report on which this sale is claimed to be exempt.
*If delivery was by common or contract carrier employed by dealer, or was delivered directly form the factory to a point outside Maine by someone other than the dealer, please explain manner
of delivery, giving name and address of delivery carrier, on back of this sheet. In such cases the dealer should retain in his files documentary evidence of such delivery.
ST-MV-36
12/10/63 Rev. 6/84
AFFIDAVIT OF EXEMPTION
(To support out-of-state delivery)
Maine Affidavit of Exemption Form