Form Rev 27 - Washington Buyer'S Affidavit

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Buyer’s Affidavit
To Be Completed By The Buyer When The Vehicle
Is Delivered To The Buyer Within Washington State
I,
, swear that:
Name of Buyer
I am a resident of the State of
. I am not a resident of the state of
Washington and do not claim to be a resident of Washington for any purpose. My home address is
,
,
Street and Number or Rural Route
City, Town, or Post Office
State
Zip Code
On
, I purchased from
the following vehicle:
Date
Name of Seller
Make:
Model:
Year:
Serial No. (VIN):
I am purchasing this vehicle for use outside Washington State. The vehicle will be removed from
Washington state by the following means: (Select and complete one)
A.
The vehicle will be driven from the seller’s premises under the authority of a trip permit,
numbered
, which has been issued to me by the Washington State
Department of Licensing or any agency of another state that has authority to issue similar permits:
or
B.
The vehicle will not be used in Washington State for more than three months and has been
licensed in the state of
. That state has issued to me license
plates numbered
. Those license plates are valid until
.
The plates have been affixed to the vehicle before it has left the seller’s premises.
I, the undersigned buyer, understand that by completing and signing this affidavit I am swearing that I
qualify for the tax-exempt purchase of the vehicle described above. In addition, I understand that false or
erroneous use of this affidavit will result in liability for unpaid tax with interest and may result in additional
penalties.
Service No. if Member of Armed Services:
Buyer’s Signature:
Date:
Witnessed by (signature):
Date:
Witnessed by (print name):
For tax assistance, visit dor.wa.gov or call 1-800-647-7706. To inquire about the availability of this document in an alternate
format for the visually impaired, please call (360) 705-6715. Teletype (TTY) users may call 1-800-451-7985.
REV 27 0002 (3/13/08)

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