Washington Buyer’s Affidavit for In-State Delivery of Motor Vehicles

Buyer’s Affidavit for In-State Delivery of Motor Vehicles 
Microsoft Word - 27 0002.docx
Reset This Form

Buyer’s Affidavit for
In-State Delivery of Motor Vehicles
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

On

,
City, Town, or Post Office

, I purchased from
Date

State

Zip Code

the following vehicle:
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
plates numbered

. That state has issued to me license
. 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 or to inquire about the availability of this document in an alternate format, please call 1-800-647-7706.
Teletype (TTY) users may use the Washington State relay Service by calling 711.
REV 27 0002 (10/15/14)

Print This Form