Form 71a101 - Motor Vehicle Usage Tax Multi-Purpose Form printable pdf download

Form 71a101 - Motor Vehicle Usage Tax Multi-Purpose Form

71A101 (05-16)

MOTOR VEHICLE USAGE TAX

Commonwealth of Kentucky

DEPARTMENT OF REVENUE

MULTI-PURPOSE FORM

SECTION A

Date__________________

Plate Number _________________________ Title Number ________________________________________________

Vehicle Identification Number (VIN) __________________________________________________________________

Registration County _________________________ Year ______________ Make _____________ Model __________

Registration Applicant’s Name _______________________________________________________________________

(Signature required in applicable section of form for proper completion.)

The Department of Revenue may deny the exemption claimed if form is incomplete or requested documentation is not submitted.

Applicant(s) will be liable for any additional tax, plus applicable penalty and interest.

SECTION B



Spouse/Spouse

(Step) Parent/(Step) Child

Grandparent/Grandchild

I, __________________,_________________________ , am the __________________ of __________________________ .

(Printed Name)

(Signature)

(Relationship)

(Name)

I, __________________,_________________________ , am the __________________ of __________________________ .

(Printed Name)

(Signature)

(Relationship)

(Name)

I, __________________,________________________ , am the ___________________ of __________________________ .

(Printed Name)

(Signature)

(Relationship)

(Name)

I, __________________,________________________ , am the ___________________ of __________________________ .

(Printed Name)

(Signature)

(Relationship)

(Name)

All Persons Involved in a Multi-line Transfer Must be Kentucky Residents.

SECTION C

Under penalties of perjury, I __________________________________________ , _______________________________ ,

(Name)

(Grade)

___________________________ , and am stationed in Kentucky at ______________________________ on active

(Service Number)

(Military Base)

military duty under orders of the United States Government.



Kentucky Resident

Documentation showing duty in the Commonwealth under U. S. Government orders must be attached.



Non-resident military

Copy of Current Leave Earning Statement (less than 120 days old) must be attached.

(Signature of Serviceperson Claiming Exemption)

(Date)

(Applicable to military personnel stationed in Kentucky who purchase a vehicle from Kentucky dealers only.)

Form 71a101 - Motor Vehicle Usage Tax Multi-Purpose Form

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