Form St-10 - Motor Vehicle Sales And Use Tax Exemption Report

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ST-10
STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
(6-06, R-12)
DIVISION OF TAXATION
MOTOR VEHICLE SALES AND USE TAX EXEMPTION REPORT
(See Reverse Side for Instructions and Definitions)
Motor Vehicle Dealer _____________________________________________________________________________________________________________
Address ________________________________________________________________________________________________________________________
Telephone Number ____________________________________________________
Taxpayer ID Number _____________________________________
I PURCHASE INFORMATION
(a) Purchaser/Lessee (please print or type)______________________________________________________________________________
(b) FID # or last three (3) digits of your SS#_____________________________
(c) Date of Purchase/Lease _______________________
(d) New Jersey Address_____________________________________________________________________________________________
(e) Out-of-State Address ___________________________________________________________________________________________
(f) Telephone Number - ( __________) _____________________ (g) Occupation _____________________________________________
(h) Employer ___________________________________________ (i) Address ________________________________________________
(j) Driver’s License issued by State of: ___________ Number ___________________________ Expiration Date ____________________
(k) Other Driver’s License Issued by State of: _________ Number _______________________ Expiration Date ___________________
II VEHICLE IDENTIFICATION DATA
Make of Vehicle _____________________________________ Model _____________________________ Year _______________
Full Serial number ____________________________________ Body Type _________________________ Color _______________
III COMPUTATION OF PRICE
(a) Enter Full Purchase Price/Lease Payment & Number of Payments . . . . . . . . . . . . . . . . . . . . . $ ________________________________
(b) Enter Trade-In Allowance or Discount, if any . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $________________________________
(c) Adjusted Purchase Price/Lease (Item A Less Item B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $________________________________
Make of Vehicle
Model
Year
State of Registration
Full Serial Number
Body Type
Color
Plate Number
IV EXEMPTION CERTIFICATION
The purchaser/lessee certifies he/she is a nonresident of New Jersey, has no permanent place of abode in New Jersey, is not engaged in
carrying on in New Jersey any employment, trade, business or profession in which the motor vehicle will be used in New Jersey.
Sign Here _________________________________________________________________________
Purchaser/Lessee (if corporation, an authorized officer must sign)
(Date)
V DEALER OF CERTIFICATION
I certify that I have examined the above form after its completion and the information given is true and correct to the best of my knowledge
and belief.
Sign Here _________________________________________________________________________
Dealer
(Date)
PRIVACY ACT NOTIFICATION
The Federal Privacy Act of 1974 requires all agencies requesting information to inform individuals from whom it seeks information why the
request is being made and how the information is being used.
Your social security number is used primarily to account for and give credit for tax payments. It is also used in the administration and
enforcement of all tax laws for which the Division of Taxation has statutory responsibility.
THIS FORM MAY BE REPRODUCED WITHOUT PRIOR AUTHORITY

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