R-1368 (1/09)
Non-Resident Motor Boat Purchase
for Registration in Another State
Louisiana Revised Statute 47:305.10(B)(4)
PLEASE PRINT OR TYPE.
Buyer Information
I, the purchaser, certify that I am not a resident of Louisiana and do not intend to register this motor boat in Louisiana. I understand that
this information will be forwarded to the Louisiana Department of Revenue and will be shared with my resident state.
Buyer’s Name
Buyer’s Driver’s License Number
Issuing State
Company Name
Buyer’s Address
City
State
ZIP
Buyer’s Telephone Number
(
)
Date
Buyer Signature
(mm/dd/yyyy)
X
The property described below will be registered in the State of
Boat Identification
Net Sales Price
Hull ID Number
State or U.S. Coast Guard Registration Number
■
■
New
Used
Boat Make
Boat Model
Boat Year
Boat Serial Number
■
■
■
■
■
■
Construction:
Wood
Aluminum
Steel
Fiberglass
Plastic
Other ___________________________
Motor Make
Motor Model/Horsepower
Motor Year
Motor Serial Number
■
■
■
■
■
■
Power:
Inboard
Outboard
Other_____________________
Fuel:
Gasoline
Diesel
Other___________
Seller Information
Seller’s Name
Seller’s Louisiana Sales Tax Registration Number (if applicable)
Seller’s Location Address
City
State
ZIP
Seller’s signature
Date
(mm/dd/yyyy)
X
Note: This form must be executed in triplicate. Two copies of this form must be sent to the Louisiana Department of Revenue, Taxpayer
Services Division, P.O. Box 201, Baton Rouge, LA 70821-0201. A copy of this certificate along with a copy of the non-resident's
drivers license must be retained by the seller for compliance purposes.