Kentucky Out-Of-State Purchase - Use Tax Affidavit

Out-Of-State Purchase - Use Tax Affidavit
Form 51A280
51A280 (7-13)
Commonwealth of Kentucky
DEPARTMENT OF REVENUE

OUT-OF-STATE PURCHASE–USE TAX AFFIDAVIT
(Document for use by taxpayers purchasing tangible property
from out–of–state for title or first–time registration)

TO BE COMPLETED BY TAXPAYER
Property Information
Type: (Check one)	

 
Trailer        
Boat        
Manufactured Home        
ATV 

		

 
Other (describe)  _ __________________________________________________

Year ____________________  Make  ______________________________   Model  ______________________________ 
VIN (if applicable)  _____________________________  Title (if applicable)  ______________________________
Purchaser’s Information

Name of Purchaser (Print)	

Signature	

KY Driver’s License #

Address of Purchaser

Seller’s Information
Name of Seller (Print)	

Date of Sale	

Sales Price (Attach Documentation)

Address of Seller

Notary Information
Attesting Official	

Title

Subscribed and sworn to before me this  __________  day of	  ______________________________,  20­­­____.
My commission expires  ___________________________________________________________________.
Note to Taxpayer: Retain a copy of this form, along with your registration receipt document, for proof of use tax paid, or exemption claimed.
TO BE COMPLETED BY COUNTY CLERK     County  _________________________
Use Tax Collected  $____________________ 
If use tax is not collected, check one of the following:

	 Code U1 (Occasional Sale) —KRS 139.010(15)
	 Code U2 (Resale Certificate)—Attach Form 51A105.
	 Code U3 (Purchase Exemption)—Attach completed Form 51A126.
	 Code U4 (Agricultural Exemption)—Attach completed Form 51A158.
	 Code U5 (Fifth Wheel Trailer)—KRS 139.470(21)–Trailer mounted in a truck bed and designed for carrying freight
	
> 1,000 lbs.; does not include bumper hitch trailers.
If a use tax credit was given, check one of the following:
	 Code U8 (Credit for sales tax paid to another state)—Attach copy of receipt.
	 Code UC (Credit for Kentucky use tax previously reported and paid)—Attach copy of receipt.
Note to County Clerk:   Any and all sales and use tax documents associated with the above transactions must be attached and submitted to the
Motor Vehicle Usage Tax Section, bundled separately from other usage tax documents currently supplied.
COPY DISTRIBUTION:   WHITE—Department of Revenue    CANARY—County Clerk    PINK—Taxpayer