Any dealer or seller who willfully prepares a false or fraudulent Nebraska Sales/Use Tax and Tire Fee Statement may be found guilty of a Class IV felony and will, upon conviction, be fined not more than $10,000, or be imprisoned not more than five years or both. Under penalties of law, I declare that I have
If exempt category 1 through 7 is claimed, requested information must be entered. Only categories 5 and 12 are exempt from the tire fee.
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Type of Exemption |
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Type of Exemption |
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1 |
Purchase by an exempt organization holding a Certificate of Exemption issued |
7 |
Purchase by a disabled person with funds contributed by the U.S. Department |
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by the Nebraska Department of Revenue. |
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of Veterans Affairs or the Nebraska Department of Health and Human Services |
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Number 05 – ______________________ |
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Finance and Support. Enter amount of contribution: $ _________________. See |
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instructions for “Purchase of a Motor Vehicle by a Disabled Person.” |
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2 |
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Vehicle will be used in a common or contract carrier capacity and the purchaser |
8 |
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Purchase by a governmental entity not engaged in the business of furnishing |
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shown on the face of this form holds a current Certificate of Exemption issued by |
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gas, water, electricity, or heat. |
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the Nebraska Department of Revenue. Number 05 –_____________________ |
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3 |
Purchase by a lessor of motor vehicles. Sales tax on the fair market lease payments |
9 |
Vehicle is the subject of an intercompany sale between parent, subsidiary, or |
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to be remitted under Nebraska Sales Tax Permit. |
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brother-sister companies.Sales tax was paid by the seller company on its purchase |
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Lessor’s Sales Tax Number 01 – ______________________ |
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of this vehicle. (Documentation required.) |
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4 |
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10 |
Vehicle is a gift or received by inheritance and tax was previously paid by the |
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Purchase under the Lessor’s Option and the motor vehicle will be leased to a |
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donor. A gift is a voluntary transfer without any consideration. The donor paid the |
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common or contract carrier who holds a valid Nebraska Certificate of Exemption |
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tax on the previous transfer. If the person accepting the motor vehicle or trailer |
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Number 05-______________________. |
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as a gift or inheritance assumes a lien, mortgage, or encumbrance, the amount |
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Lessor must attach a copy of approved Nebraska Application for Election |
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owing shall be subject to sales and use tax. (Documentation required.) |
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of Lessors to Pay Sales and Use Tax on Cost of Motor Vehicles, Form 15. |
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11 |
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5 |
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Transfer of |
the vehicle during the creation, |
reorganization, or dissolution of |
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Purchase by a Native American Indian residing on a Nebraska reservation and |
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a corporation, limited liability company, or partnership solely for voting stock |
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the vehicle is registered at a location within the boundaries of the reservation. |
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membership interest or partnership interest.Also, transfer of a vehicle as additional |
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Tax Exemption ID Card Number: ________________________ |
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capital to an ongoing corporation. (Documentation required.) |
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6 |
Vehicle was purchased, licensed, and operated in a state other than Nebraska. |
12 |
Purchase of a 30-day plate by a nonresident of Nebraska who does not intend |
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Identify state: _____________________________ (Documentation required.) |
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to remain in Nebraska more than 30 days from the date of purchase. |
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Any purchaser or agent who completes this exemption certificate for any purchase which is not exempt under the Nebraska Revenue Act, as amended, |
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will in addition to any tax, interest, or penalty otherwise imposed, be subject to a penalty of $100 or ten times the tax, whichever amount is larger. Under |
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sign |
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penalties of law, I declare that I have examined this certificate and to the best of my knowledge and belief, it is correct and complete. |
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here |
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Signature of Person Claiming Exemption |
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Date |
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FOR COUNTY USE ONLY |
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$_____________________ |
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Tax Paid |
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______________________ |
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Date Paid |
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NEBRASKA DEPARTMENT OF REVENUE — White and Green Copies |
COUNTY — Yellow Copy |
PURCHASER — Blue Copy |
SELLER — Pink Copy |