Form 5095 PDF Details

Form 5095 is an Internal Revenue Service (IRS) form used to claim a common carrier tax exemption. This form includes the purchaser's name and address, the lessee's name and address, and vehicle information. Completing this form accurately ensures that the applicant claiming a common carrier sales tax exemption will receive it. If you have any questions about how to complete Form 5095, please consult a tax professional.

QuestionAnswer
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

Form Preview Example

 

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

 

 

 

 

__ __ /__ __ /__ __ __ __

 

 

 

 

 

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)

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Year

 

 

Make

 

 

 

 

 

 

Model

 

 

 

 

 

Licensed Gross Weight

State of Licensure

__ __ __ __

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number (VIN)

 

 

 

 

 

 

 

 

 

 

Purchase or Lease Date (MM/DD/YYYY)

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__ __ /__ __ /__ __ __ __

 

Year

 

 

Make

 

 

 

 

 

 

Model

 

 

 

 

 

Licensed Gross Weight

State of Licensure

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Vehicle Identification Number (VIN)

 

 

 

 

 

 

 

 

 

 

Purchase or Lease Date (MM/DD/YYYY)

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__ __ /__ __ /__ __ __ __

 

Year

 

 

Make

 

 

 

 

 

 

Model

 

 

 

 

 

Licensed Gross Weight

State of Licensure

__ __ __ __

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Identification Number (VIN)

 

 

 

 

 

 

 

 

 

 

Purchase or Lease Date (MM/DD/YYYY)

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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

Visit dor.mo.gov/pdf/commoncarriers.pdf

 

Jefferson City, MO 65105-0100

E-mail: mvbmail@dor.mo.gov

for additional information.

How to Edit Form 5095 Online for Free

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Step 1: Hit the "Get Form" button at the top of this page to access our PDF editor.

Step 2: Once you start the file editor, you will notice the document made ready to be completed. Besides filling out different blanks, you may also do various other things with the file, including writing custom textual content, editing the original text, inserting images, putting your signature on the PDF, and a lot more.

This form will require particular info to be filled out, hence ensure that you take whatever time to enter what is requested:

1. First, while completing the missouri tax exemption form 5095, start in the section that includes the subsequent blanks:

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)

Be really careful when filling out Model and Make, since this is the part in which many people make a few mistakes.

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