Form Rv-F1304401 - Tennessee Sales Or Use Tax Certification Of Interstate Delivery By Seller For Automobiles, Other Motor Vehicles, Aircraft, Trailers And Boats
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1TENNESSEE DEPARTMENT OF REVENUE
ANDREW JACKSON STATE OFFICE BULDING
NASHVILLE, TENNESSEE 37242
TENNESSEE SALES OR USE TAX
CERTIFICATION OF INTERSTATE DELIVERY BY SELLER
FOR AUTOMOBILES, OTHER MOTOR VEHICLES, AIRCRAFT, TRAILERS AND BOATS
Trade Name of Dealer
Address of Dealer
City, State, Zip
Sales Tax Registration Number
Transaction Invoice Number
Date of Sale
Name of Purchaser
Address of Purchaser
Phone (
)
City, State, Zip
Description of Automobile, Other Motor Vehicle, Aircraft, Trailer, or Boat
Make
Year
Model
(
) New
(
) Used
Serial Number
Motor Number
Total Selling Price $
Trade-in $
Net $
FAA Number
AFFIDAVIT OF DEALER AND CUSTOMER
State of Tennessee
County of
We, the undersigned dealer and customer or representative thereof, do hereby affirm that the named dealership will physi-
cally deliver the described article to (city)
, (state)
to be titled or registered there if required by the laws of that state. We understand that falsification of this document for the
purpose of tax evasion and the acceptance of possession of the article within Tennessee by the customer will subject the
dealership to the appropriate sales tax, business tax, penalties, and interest as prescribed by law.
(Print) Purchaser's Name
(Print) Dealer's Name
Signature
Signature
day of
, 2
Subscribed and sworn to me this
day of
, 2
My commission expires the
(Signed)
(Notary Public)
This certification must be prepared and executed in duplicate by the dealer and purchaser at the time of the sale of the
articl
The original is retained in the dealership file for audit purposes with a copy provided to the customer for his records
e.
or for use in his home state. DEALERS: DO NOT FORWARD COPIES WITH YOUR SALES OR BUSINESS TAX
RETURNS. Failure of the dealer to actually deliver the article to a point outside of Tennessee will subject such dealer to
the full tax plus penalties and interest as applicable.
INTERNET (2-08)
RV-F1304401
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Form Rv-f1304401 - Certification Of Interstate Delivery By Seller For Automobiles, Other Motor Vehciles, Aircraft, Trailers And Boats - Tennessee Department Of Revenue
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