DR 0780 (08/30/13)
COLORADO DEPARTMENT OF REVENUE                                               *130780==19999*
Denver, CO 80261-0009
303-238-7378

                         Statement of Colorado Sales Tax Exemption
                               For Motor Vehicle Purchase

Vehicles delivered to a nonresident of Colorado to be licensed outside the state of Colorado are exempt from Colorado 
sales tax under the provisions of 39-26-113(5) or 39-26-719(2)(a) C.R.S., as amended. The vehicle is not to be licensed or 
registered in Colorado and must be removed from the state of Colorado within thirty (30) days of purchase.

Type of vehicle purchased:       Automobile (notarization not required)   Truck-tractor        Trailer
                       Recreational Vehicle   Truck                       Truck bed            Semi-trailer
Year              Make                                                  VIN

Purchase Date (MM/DD/YY)                         Net Sales Price

Purchaser’s Last Name                       First Name                                                          Middle Initial

Purchaser’s Address                                                          Purchaser is a resident of (state)

City                                                                                         State              Zip

Dealer’s Name

Dealer’s Address                            City                                             State              Zip

The purchaser hereby swears that the above described vehicle will be removed from Colorado within thirty (30) days 
from the date of purchase and that the vehicle will be licensed, registered and used outside of Colorado or in  
interstate commerce.
Signature of Purchaser                                                                  Date (MM/DD/YY)

                               This form is to be kept in the seller’s files.