Form 72 315 04 1 1 000 – Fill Out and Use This PDF

FOR THE FOLLOWING TYPES OF EQUIPMENT AND TANGIBLE PERSONAL PROPERTY.

Airplanes, farm tractors, farm implements, heavy equipment, boats, boat motors, manufactured houses, trailers, motorcycles ATVs, recreational vehicles, travel trailers, furniture, and appliances.

Seller:

Sales Tax Number:

Trade Name:

City, State, Zip:

Purchaser:

Date Sold:

Invoice #:

Street:

City, State, Zip:

Phone:

The property described below will be used or registered in the State of

#1

#2

#3

Type of Equipment

Make

Model

Year

Serial Number

Net Sales Price

Seller's Oath

The undersigned Seller, or authorized representative thereof, being duly sworn according to law, does hereby certify that the above-described property has been sold exempted for Mississippi sales tax for the above reason and that all information shown hereinabove is true and correct.

Signature of Seller or Authorized Representative:

The burden of proof of this exemption rests with the Seller, and its allowance is subject to verification by the Commissioner. Willfully attempting in any manner to evade or defeat any tax imposed by the Mississippi State Tax Commission will subject that person to the penalties imposed by Section 27-3-79 and 27-65-31 as shown on the back of this form.

	Purchaser's Oath
State of Mississippi, County of		Reason for Exemption:		Out of State Delivery
				48 Hour Drive Out

The undersigned Purchaser, or authorized representative thereof, being duly sworn according to law, does hereby certify that the above-described property has been sold exempted for Mississippi sales tax for the above reason and that all information shown hereinabove is true and correct. The purchaser is responsible for the use tax on any equipment purchased for

use in their home state.

Print Name of Purchaser:

Signature of Purchaser or Authorized Representative:

If Delivered, Place of Delivery:

Date of Delivery:

This form is to be executed in triplicate and attached in duplicate to the sales tax return. ORIGINAL AND SECOND COPY FOR MSTC. THE COPY FOR SELLER'S RECORDS. FOR TAX COMPLIANCE, A COPY OF THIS FORM WILL BE FORWARDED TO THE REVENUE DEPT. OF THE STATE WHERE THE EQUIPMENT WAS DELIVERED.