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Nebraska Sales Tax Statement Form

The Nebraska Sales Tax Statement form is a crucial document for anyone selling a motor vehicle or trailer in Nebraska. This form must be filled out by the seller and provided to the buyer at the time of sale. For those looking to complete this form, click the button below to get started.

Open This Nebraska Sales Tax Statement

Structure

The Nebraska Sales Tax Statement form is an essential document for anyone selling a motor vehicle or trailer in the state. This form ensures that both the seller and purchaser have a clear record of the transaction, including important details like the names and addresses of both parties, as well as the specifics of the vehicle being sold. It includes sections for the vehicle's make, body type, year, and Vehicle Identification Number (VIN). Additionally, the form outlines the tax computation process, detailing how to calculate the sales tax based on the total sales price, any trade-in allowances, and applicable manufacturer rebates. It's important to note that the seller must provide this statement to the buyer, who will need to present it to the county treasurer or the Department of Motor Vehicles (DMV) within 30 days of purchase to pay the necessary taxes and fees. The form also addresses various exemptions that may apply, such as purchases made by exempt organizations or disabled individuals. Understanding this form is crucial for both buyers and sellers to ensure compliance with Nebraska's tax regulations and to avoid potential penalties for incorrect filings.

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Every person who sells a motor vehicle or trailer should complete this statement and give it to the purchaser. This form can be obtained by contacting the Department or the county treasurer of the county in which it will be registered.

Nebraska Sales/Use Tax and Tire Fee Statement

for Motor Vehicle and Trailer Sales

FORM

PURCHASER’S NAME AND ADDRESS			SELLER’S NAME AND ADDRESS
Name			Name

Street or Other Address			Street or Other Address

City	State	Zip Code	City	State	Zip Code

PURCHASED VEHICLE/TRAILER DESCRIPTION

Make	Body Type	Year	Vehicle Identiﬁcation Number (VIN)	Date of Purchase

Make

TRADE-IN VEHICLE/TRAILER DESCRIPTION

Body Type	Year	Vehicle Identiﬁcation Number (VIN)	License Plate Number	Was trade-in vehicle being leased?
				YES	NO
				If Yes, enter 0 on line 2.

TAX COMPUTATION — See Instructions

1	Total sales price		1	$
2	Less trade-in allowance		2
3	Less manufacturer’s rebate assigned to dealer at time of sale		3
4	Tax base (line 1 minus lines 2 and 3) (if zero or less, enter 0)		4	$
5	Nebraska sales or use tax (line 4 multiplied by rate)	5
6	Local sales or use tax (line 4 multiplied by rate)	6
7	Total Nebraska and local tax due (line 5 plus line 6)		7	$
8	Tire Fee (Number of new tires ______ multiplied by $1)		8
9	Penalty for late payment		9
10	Interest for late payment		10
11	BALANCE DUE (total of lines 7, 8, 9, and 10)		11	$

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

sign	examined this statement and it is correct and complete.
	examined this statement and it is correct and complete.
here Signature of Seller		Signature of Purchaser or Agent of Purchaser	Date

Nebraska Resale or Exempt Sale Certiﬁcate for Motor Vehicle and Trailer Sales

If exempt category 1 through 7 is claimed, requested information must be entered. Only categories 5 and 12 are exempt from the tire fee.

Type of Exemption

Purchase by an exempt organization holding a Certiﬁcate of Exemption issued

Purchase by a disabled person with funds contributed by the U.S. Department

by the Nebraska Department of Revenue.

of Veterans Affairs or the Nebraska Department of Health and Human Services

Number 05 – ______________________

Finance and Support. Enter amount of contribution: $ _________________. See

instructions for “Purchase of a Motor Vehicle by a Disabled Person.”

Vehicle will be used in a common or contract carrier capacity and the purchaser

Purchase by a governmental entity not engaged in the business of furnishing

shown on the face of this form holds a current Certiﬁcate of Exemption issued by

gas, water, electricity, or heat.

the Nebraska Department of Revenue. Number 05 –_____________________

Purchase by a lessor of motor vehicles. Sales tax on the fair market lease payments

Vehicle is the subject of an intercompany sale between parent, subsidiary, or

to be remitted under Nebraska Sales Tax Permit.

brother-sister companies.Sales tax was paid by the seller company on its purchase

Lessor’s Sales Tax Number 01 – ______________________

of this vehicle. (Documentation required.)

Vehicle is a gift or received by inheritance and tax was previously paid by the

Purchase under the Lessor’s Option and the motor vehicle will be leased to a

donor. A gift is a voluntary transfer without any consideration. The donor paid the

common or contract carrier who holds a valid Nebraska Certiﬁcate of Exemption

tax on the previous transfer. If the person accepting the motor vehicle or trailer

Number 05-______________________.

as a gift or inheritance assumes a lien, mortgage, or encumbrance, the amount

Lessor must attach a copy of approved Nebraska Application for Election

owing shall be subject to sales and use tax. (Documentation required.)

of Lessors to Pay Sales and Use Tax on Cost of Motor Vehicles, Form 15.

Transfer of

the vehicle during the creation,

reorganization, or dissolution of

Purchase by a Native American Indian residing on a Nebraska reservation and

a corporation, limited liability company, or partnership solely for voting stock

the vehicle is registered at a location within the boundaries of the reservation.

membership interest or partnership interest.Also, transfer of a vehicle as additional

Tax Exemption ID Card Number: ________________________

capital to an ongoing corporation. (Documentation required.)

Vehicle was purchased, licensed, and operated in a state other than Nebraska.

Purchase of a 30-day plate by a nonresident of Nebraska who does not intend

Identify state: _____________________________ (Documentation required.)

to remain in Nebraska more than 30 days from the date of purchase.

Any purchaser or agent who completes this exemption certiﬁcate for any purchase which is not exempt under the Nebraska Revenue Act, as amended,

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

sign

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.

here

Signature of Person Claiming Exemption

Date

FOR COUNTY USE ONLY

$_____________________

Tax Paid

______________________

Date Paid

NEBRASKA DEPARTMENT OF REVENUE — White and Green Copies

COUNTY — Yellow Copy

PURCHASER — Blue Copy

SELLER — Pink Copy

NEBRASKA DEPARTMENT OF REVENUE, PO BOX 94818, LINCOLN, NE 68509-4818

6-004-1967 Rev. 7-2011 Supersedes 6-004-1967 Rev. 7-2009

INSTRUCTIONS FOR PURCHASER

PAYMENT OF TAX AND TIRE FEE. The purchaser of a motor vehicle or trailer must present the white, yellow, and blue copies of this statement to the county treasurer, the Department of Motor Vehicles (DMV), or other designated county oficial within 30 days from the date of purchase, and pay the Nebraska and local sales and use tax, and the tire fee. The date of purchase is the earlier of two dates: the date on the motor vehicle title; or the date of possession, as evidenced by the Nebraska Sales/Use Tax and Tire Fee Statement, Form 6. The purchaser should retain their copy of this statement for a period of at least ive years.

PENALTY AND INTEREST. If the total taxes and tire fee are not paid within 30 days of the purchase date, the county treasurer, DMV, or designated county oficial will assess and collect penalty and interest at the statutory rate. If you have any questions regarding the due date, or penalty and interest rates, please contact your local county treasurer’s ofice or call the Nebraska Department of Revenue (Department), 800-742-7474 (NE and IA) or www.revenue.ne.gov.

SALES TAX PAID TO ANOTHER STATE. A motor vehicle purchased in another state, with sales tax properly paid to the other state, but registered for the irst time in Nebraska, is subject to sales or use tax at the time of registration. If the state the vehicle was purchased in has reciprocity with Nebraska, the total sales tax paid in that state will be credited toward the total state and local sales tax due in Nebraska. No refund will be made if the other state’s tax rate exceeds the total Nebraska and local option sales tax rate.

LINE 4. No refund will be made if the tax base results in a negative amount.

EXEMPTIONS. If the transfer of title to the motor vehicle or trailer described on this statement is exempt from sales and use tax, the Nebraska Resale or Exempt Sale Certiicate, located on the front of this statement, must be completed prior to registration.

The purchaser must present documentation that supports the exemption. If the documentation is not suficient, the county treasurer, DMV, or other designated county oficial is authorized to collect the tax. The purchaser may submit a claim to the Department requesting that the taxes and fees paid be refunded.

PURCHASE OF A MOTOR VEHICLE BY A DISABLED PERSON. If the amount contributed by the U.S. Department of VeteransAdministration (VA) or the Nebraska Department of Health and Human Services (DHHS) is the maximum amount allowed by law, the entire purchase price of the motor vehicle is exempt from sales tax. The entire purchase price is exempt, even if the purchase price is greater than the maximum amount contributed. If the contributed amount is less than the maximum amount allowed by law, only the amount contributed is exempt from sales tax. If there is a question as to whether the maximum amount was received, Form 21-4502 “Application for Automobile or Other Conveyance and Adaptive Equipment” issued by the VA, or the award letter issued by the DHHS, should be reviewed.Amotor vehicle purchased with disability compensation is not exempt from sales tax.

MOBILITY ENHANCING EQUIPMENT. Any disabled or handicapped person who is required to use durable medical equipment or prosthetics for moving from one place to another place, may purchase mobility enhancing equipment with a motor vehicle exempt from sales tax. Please refer to the Nebraska Certiicate of Exemption for Mobility Enhancing Equipment on a Motor Vehicle, Form 13ME.

UNDERPAYMENT OF TAX. Underpayment of sales and use tax or tire fee on this statement must be reported on an Amended Nebraska Sales/Use Tax and Tire Fee Statement for Motor Vehicle and Trailer Sales, Form 6XN. Form 6XN is available at each county treasurer’s ofice and the Department.

INSTRUCTIONS FOR SELLER

LICENSED MOTOR VEHICLE DEALER OR LICENSED PERMIT HOLDER. A motor vehicle dealer, or sales tax permit holder, must complete this statement for every sale of a motor vehicle or trailer. The colored copies should be distributed in the following manner:

1.The pink copy must be retained with your business records;

2.The green copy must be mailed with the Nebraska and Local Sales and Use Tax Return, Form 10; and

3.The white, yellow, and blue copies must be given to the purchaser.

The sales price on line 1 shall include charges for items such as destination charges, import custom fees, surcharges, service and maintenance agreements, document processing charges, charges for warranty transfers, and dealer-installed options.

INDIVIDUAL WITHOUT A SALESTAX PERMIT. An individual, who is not licensed to collect sales tax, must complete this statement

for every sale of a motor vehicle or trailer. The colored copies should be distributed in the following manner:

1.The pink copy must be retained with your records; and

2.The white, yellow, and blue copies must be given to the purchaser.

An individual can only accept another motor vehicle or trailer as a trade-in to reduce the total sales price of the purchased motor vehicle or trailer.

LEASED VEHICLES. A lessee cannot use the previously-leased vehicle as a trade-in on the purchase of a new or used vehicle, unless the lessee has registered and paid the tax on the buy-out amount.

TIRE FEE. Motor vehicle dealers selling new motor vehicles, trailers, or semi-trailers are required to indicate the number of tires, including the spare, on line 8. Dealers must also indicate

the number of new tires on a previously-owned vehicle.

Individuals selling used motor vehicles are not required to indicate the number of tires.

INSTRUCTIONS FOR COUNTY TREASURERS, DMV,

AND OTHER DESIGNATED COUNTY OFFICIALS

COLLECTION OF TAX AND TIRE FEE. The county treasurer,

DMV, or other designated county oficial must collect the state and applicable local sales and use tax, and the tire fee, prior to registering the motor vehicle or trailer.

The white, yellow, and blue copies of this statement must be receipted in the space provided for validation. The blue copy must be returned to the purchaser. The yellow copy must be retained in your iles, and the white copy must be submitted with your monthly returns.

COLLECTION OF PENALTY AND INTEREST. If the appropriate taxes and fees are not paid within 30 days of the purchase date, penalty and interest must be collected at the statutory rate from the due date through the date of payment. If the due date falls on a Saturday, Sunday, or a holiday, the purchaser may still pay the amount due on the next business day without incurring penalty and interest.

NEBRASKA DEPARTMENT OF REVENUE, PO BOX 94818, LINCOLN, NE 68509-4818

⇓ PDF File

File Information

Fact Name	Details
Purpose	This form is required for every sale of a motor vehicle or trailer.
Obtaining the Form	Contact the Department of Revenue or the county treasurer to obtain this form.
Tax Computation	It includes a detailed section for calculating sales tax, local tax, and tire fees.
Exemption Categories	There are specific categories under which sales may be exempt from tax.
Penalties	Filing a false statement may result in a Class IV felony charge.
Documentation	Supporting documents are required for tax exemptions to be valid.
Submission Deadline	The completed form must be presented within 30 days of purchase.
Retention Period	Purchasers should keep their copy of the form for at least five years.
Governing Law	The form is governed by Nebraska Revised Statutes § 77-2701 et seq.

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