1 |
Total sales price |
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1 |
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2 |
Less trade-in allowance |
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2 |
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Less manufacturer’s rebate assigned to dealer at time of sale |
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3 |
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3 |
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Tax base (line 1 minus lines 2 and 3) (if zero or less, enter -0-) |
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4 |
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4 |
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5 |
Nebraska sales or use tax (line 4 multiplied by rate) |
5 |
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Local sales or use tax (line 4 multiplied by rate) |
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6 |
6 |
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Total Nebraska and local sales or use tax due (line 5 plus line 6) |
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7 |
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7 |
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Tire fee (Number of new tires ______ multiplied by $1) |
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8 |
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8 |
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Penalty for late payment |
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9 |
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9 |
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Interest for late payment |
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10 |
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10 |
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11 |
Balance due (total of lines 7, 8, 9, and 10) |
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11 |
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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 person with a disability 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 Person with a Disability.” |
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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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the Nebraska Department of Revenue. Number 05 –_____________________ |
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gas, water, electricity, or heat. |
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3 |
Purchase by a lessor of motor vehicles. Sales tax on the fair market lease payments |
9 |
Purchase of a header trailer, head hauler, header transport, or seed tender trailer |
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to be remitted under Nebraska Sales Tax Permit. |
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that is depreciable agricultural machinery and equipment for use in commercial |
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Lessor’s Sales Tax Number 01 – ______________________ |
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agriculture. (Refer to the Agricultural Machinery and Equipment Sales Tax |
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4 |
Purchase under the Lessor’s Option and the motor vehicle will be leased to a |
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Exemption Information Guide.) |
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common or contract carrier who holds a valid Nebraska Certificate of Exemption |
10 |
Vehicle is a gift or received by inheritance and tax was previously paid by the |
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Number 05-______________________. |
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donor. A gift is a voluntary transfer without any consideration. The donor paid the |
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Lessor must attach a copy of approved Nebraska Application for Election |
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tax on the previous transfer. If the person accepting the motor vehicle or trailer |
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of Lessors to Pay Sales and Use Tax on Cost of Motor Vehicles, Form 15. |
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as a gift or inheritance assumes a lien, mortgage, or encumbrance, the amount |
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5 |
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owing shall be subject to sales and use tax. (Documentation required.) |
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Purchase by a Native American Indian residing in Indian country and the vehicle |
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is registered at a location within Indian country in Nebraska. |
11 |
A transfer of a motor vehicle pursuant to an occasional sale as set out in Nebraska |
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Tax Exemption ID Card Number: ________________________ |
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Sales and Use Tax Regulation 1-022.02 through 1-022.04. |
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6 |
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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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