Form St_wc_aff - Watercraft And Outboard Motor Affi Davit Regarding Sales To A Nonresident
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1hio
ST WC AFF
Department of
Rev. 4/10
Taxation
Watercraft and Outboard Motor Affi davit Regarding Sales to a Nonresident
The undersigned purchaser hereby certifi es that on
o
o
Date
the following
Watercraft
Outboard motor was purchased from:
Seller's name
Phone number
Vendor's license number
Watercraft dealer's permit number
by
Purchaser's name
Phone number
Number and street
City, state and ZIP code
Driver's license issued by
No.
Expiration date
State
Watercraft
Model
Length
Year
Make
Outboard motor
Model
H.P.
Year
Make
Mfg. serial number
Watercraft
Outboard motor
The watercraft or outboard motor will be titled, registered or used in
County/parish
City
State
Ohio tax base $
Ohio tax
Price $
Trade-in $
State and local sales/use/excise tax that would be due in the other state $
Ownership or use in the above-referenced state is exempt from sales/use/excise tax because:
The above-named purchaser certifi es that he/she is a nonresident of this state and that possession of the watercraft and/
or outboard motor is taken in this state for the sole purpose of immediately removing it from the state o Ohio for use in an-
other state. The purchaser further states that the watercraft and/or outboard will be titled, registered and/or used in the state
indicated above and that it will not be used in this state. If the watercraft/outboard motor is returned to Ohio, the purchaser
understands that he/she is responsible for payment of additional sales or use taxes that may be due Ohio.
I have examined this affi davit and swear that same is true to the best of my knowledge and belief.
Purchaser's signature
Sworn to before me and subscribed in my presence on
Month, day, year
Notary public
(To be prepared in triplicate. Original to the clerk of courts of Ohio if Ohio title is obtained; one copy to the Department of
Taxation with the ST WC NR return; one copy to be retained by vendor.)
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