Florida Department of Revenue

Sales Tax Exemption Affidavit

_______________________________________(Make of Vehicle)

__________(Year)

________________________________________(Type)

_______________________________________(Engine or I.D. Number)

_______________(Model)

________________________________________(Florida or U.S. Title Number)

I hereby certify that transfer of ownership of the vehicle described above and on the attached Title Certificate or Application for Original Title, is not subject to the Florida Sales and Use Tax for the reason(s) checked below:

Inheritance (Regardless of lien)

Even Trade or Trade Down (Regardless of lien; state the facts of the trade in the space marked "Other")

Divorce Decree (Property settlement or court ordered division of marital property; regardless of lien)

Gift (No unpaid balance assumed)

Transfer of Marital Property Between Husband and Wife (Regardless of lien)

Other: (Explain) __________________________________________________________________________________

Signature of Transfere (Applicant): __________________________________________________ Date: ____________________

Name of Transferee: ______________________________ Name of Transferor: _______________________________________

Address: ________________________________________ Address: ________________________________________________

City: ___________________________________________ City: ____________________________________________________

State: _________________ Zip: _____________________ State: __________________________ Zip: _____________________

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE

DR-40R. 10/04