Form 5095 – Fill Out and Use This PDF

The Missouri Department of Revenue Form 5095, also known as the Sales Tax Exemption Statement, is a critical document for authorized common carriers seeking a sales tax exemption on their vehicle purchases. It is tailored for applicants who operate as common carriers and outlines the specific requirements and qualifications needed to be eligible for this exemption. Individuals or entities not qualifying under this exemption and hauling loads exceeding 54,000 lbs. must refer to Form 5435 to apply for a different sales tax exemption.

Ensure you're prepared to fulfill all the criteria outlined in Form 5095 if you're hoping to benefit from the common carrier sales tax exemption. This includes being registered as a common carrier in the relevant jurisdiction and certifying that all listed vehicles will be used for "for hire" transportation of exempt commodities, among other requirements.

To apply for your exemption now, click the button below to fill out Form 5095.

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Form 5095 PDF Details

In the landscape of tax exemptions for commercial transportation, the Missouri Department of Revenue Form 5095, also known as the Sales Tax Exemption Statement for Authorized Common Carriers, serves as a crucial document. This form, integral to maintaining the balance between regulatory requirements and the facilitation of commercial transportation activities, must be submitted alongside each title application where a common carrier sales tax exemption is claimed. It distinguishes between common carriers qualified for tax exemption and those who, not qualifying, must seek exemption via Form 5435 for vehicles hauling loads over 54,000 lbs. Detailed in the form are sections for purchaser and lessee information, including names, addresses, and specific vehicle details such as the Vehicle Identification Number (VIN), purchase or lease dates, make, model, and state of licensure. The eligibility criteria demand registration or a lease agreement with a registered common carrier, engaging in either interstate or intrastate commerce, with requisite documentation provided for verification. Furthermore, certifying the use of vehicles or trailers for "for-hire" services and meeting specified weight or passenger capacity solidifies the applicant's exempt status. Adherence to stipulations, such as the lease length and the intended use of the vehicle, underscores the commitment to regulatory compliance and the integrity of applying entities. The solemn declaration at the end, emphasizing the truthfulness and completeness of the provided information under the penalty of perjury, underscores the form's significance in upholding both legal and fiscal responsibilities. Effective communication with the Motor Vehicle Bureau, facilitated through multiple contact avenues, ensures that applicants can navigate the exemption process with clarity and support.

Question	Answer
Form Name	Form 5095
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	form 5095 87e, fform 5095, form 5095 tax exemption, missouri 5095 form

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	Missouri Department of Revenue
Form	Sales Tax Exemption Statement
5095	For Authorized Common Carriers

This form must be completed and submitted with each application for title in which the applicant is claiming a common carrier sales tax exemption. Applicants who do not qualify for the common carrier tax exemption who haul loads in excess of 54,000 lbs. must complete an Application for Sales Tax Exemption – Commercial Motor Vehicles or Trailers Greater than 54,000 Pounds (Form 5435), to apply for an exemption from sales tax.

Purchaser’s	Purchaser’s (Lessor’s) Name	Purchase Date (MM/DD/YYYY)	Purchaser’s (Lessor’s) Telephone Number
		__ __ /__ __ /__ __ __ __	(__ __ __) __ __ __ - __ __ __ __

	Purchaser’s (Lessor’s) Address	Lessee’s Address, if applicable	Lease Date if applicable (MM/DD/YYYY)
	Doing Business As	Lessee’s Name, if applicable	Lease Date if applicable (MM/DD/YYYY)
			__ __ /__ __ /__ __ __ __

Requirements to Qualify

1.The purchaser is registered (or has a lease agreement with someone who is registered) as a common carrier to provide “for hire” services in (select one):

r Interstate commerce and is registered with the Federal Motor Carrier Safety Administration (FMCSA).

Please provide: United States Department of Transportation (USDOT) registration number, if applicable:__________________________ .

FMCSA operating authority (MC) number: ___________________________________________________________________________ . r Interstate commerce hauling exempt commodities and has filed the carrier’s information with the FMCSA Safety and Fitness Electronic

Records (SAFER) System. Please provide your USDOT registration number:_______________________________________________ . r Intrastate commerce and is registered with the Missouri Division of Motor Carrier Services.

Please provide your USDOT registration number: _____________________________________________________________________ .

2.The purchaser certifies the following regarding all vehicle(s) or trailer(s) listed below.

•The purchaser (or individual named in the lease agreement) holds itself out to the public as engaging in “for hire” transportation of exempt commodities, passengers, or property of others. Please explain how the purchaser (or individual named in the lease agreement) holds itself out for hire to the public.______________________________________________________________________

•The purchaser (or individual named in the lease agreement) will use the motor vehicle(s) or trailer(s) for the purpose noted herein.

•If a lease agreement is involved, the lease is for at least 30 days.

•Each motor vehicle will be:

-Registered for, and capable of hauling or carrying, at least 24,000 lbs. or more including vehicle weight; or

-Registered as a commercial bus and capable of carrying eight or more passengers.

•If registering at a later date, provide the licensed gross weight to be applied for and the state of licensure for each motor vehicle or trailer.

Vehicle(s) Information

Vehicle Identification Number (VIN)

Purchase or Lease Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Year

Make

Model

Licensed Gross Weight

State of Licensure

__ __ __ __

Vehicle Identification Number (VIN)

Purchase or Lease Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Year

Make

Model

Licensed Gross Weight

State of Licensure

__ __ __ __

Vehicle Identification Number (VIN)

Purchase or Lease Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Year

Make

Model

Licensed Gross Weight

State of Licensure

__ __ __ __

Vehicle Identification Number (VIN)

Purchase or Lease Date (MM/DD/YYYY)

__ __ /__ __ /__ __ __ __

Year

Make

Model

Licensed Gross Weight

State of Licensure

__ __ __ __

Signature

Under penalties of perjury, I declare that the information I have provided an any attached supplement is true, correct, and complete.

Purchaser’s (or Authorized Agent) Signature	Typed or Printed Name	Date Signed (MM/DD/YYYY)
		__ __ /__ __ /__ __ __ __
		Form 5095 (Revised 08-2013)

Mail to:	Motor Vehicle Bureau	Phone: (573) 526-3669
	P.O. Box 100	Phone: (573) 526-3669	Visit dor.mo.gov/pdf/commoncarriers.pdf
	Jefferson City, MO 65105-0100	E-mail: mvbmail@dor.mo.gov	for additional information.

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Completing segment 1 of form 5095 for 2020

2. Given that the previous array of fields is complete, you're ready put in the needed specifics in Vehicle Identification Number VIN, Year, Model, Make, Vehicle Identification Number VIN, Year, Model, Make, Vehicle Identification Number VIN, Year, Model, Make, Vehicle Identification Number VIN, Year, and Model in order to move forward further.

form 5095 for 2020 writing process clarified (step 2)

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Form 5095 – Fill Out and Use This PDF

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