DR 1369 (10/01/14) 
                                     COLORADO DEPARTMENT OF REVENUE 
  *141369==19999*                    Denver, CO 80261-0009 
                                     (303) 238-SERV (7378) 
                                     www.TaxColorado.com

                    Colorado State Sales and Use Tax Exemption For 
  Low-Emitting Heavy Vehicles Affidavit (Submit one form for each vehicle)
                                                  Purchaser’s Information
Purchaser’s Name                                                                                      Purchaser’s Telephone Number
                                                                                                      (           )
Purchaser’s Address                                                         City                            State     ZIP

                                                  Vehicle Information
Sales on or before June 30, 2014
Motor vehicles greater than 10,000 pounds gross motor vehicle        the Federal Clean Air Act as meeting an emission standard equal 
weight rating (GVWR) that are certified by the United States         to or more stringent than the low-emitting vehicle (LEV) standard 
Environmental Protection Agency (EPA) or any state provided in       are exempt from state sales and use tax. [§39-26-719, C.R.S.]
Sales on or after July 1, 2014                                       Please check the appropriate box below
Please check appropriate box for the vehicle weight                   The vehicle is equipped by the manufacturer to operate on 
  Motor vehicles greater than 26,000 pounds gross motor               compressed natural gas (CNG) or liquefied petroleum gas 
  vehicle weight rating (GVWR) that are certified by the United       (LPG). The vehicle can run exclusively CNG or LPG or as a bi-
  States Environmental Protection Agency (EPA) as provided            fuel or dual fuel that can operate on traditional fuel and CNG or 
  in the federal heavy-duty national program that includes new        LPG. The vehicle is equipped with a CNG or LPG conversion 
  greenhouse gas emissions standards are exempt from state            certified by the EPA.
  sales and use tax. Parts that are certified by the EPA are also     The vehicle is equipped by the manufacturer to operate on 
  exempt from state sales and use tax when converting motor           liquefied natural gas (LNG) or hydrogen. The vehicle can run 
  vehicles greater than 26,000 pounds GVWR.                           exclusively LNG or hydrogen, or as a bi-fuel or dual fuel that 
  Motor vehicles greater than 10,000 pounds gross vehicle             can be operated on traditional fuel and LNG or hydrogen. 
  weight rating (GVWR) are exempt from state sales and use            The vehicle is equipped with a LNG or hydrogen conversion 
  tax when one of the following criteria are met:                     certified by the EPA.
                                                                      The vehicle is equipped by the manufacturer as an electricity 
                                                                      truck or plug-in hybrid electric truck. The vehicle is converted 
                                                                      to an electric truck or plug-in hybrid electric truck.
  Year              Model            Make                         Body Type Vehicle Identification Number (VIN)       Date of Sale

                                                  Qualification Documents
The following documents MUST be provided to the county clerk when the vehicle is registered in Colorado.
 A copy of this form, DR 1369 Colorado State Sales and Use            Evidence of the gross motor vehicle weight rating (GVWR)
 Tax Exemption For Low-Emitting Heavy Vehicles Affidavit              EPA certification
                                                  Dealer Information
The undersigned certifies that the referenced vehicle meets the requirements of §39-26-719, C.R.S.
Dealer’s Name                                                                                         Dealer’s Telephone Number
                                                                                                      (          )
Dealer’s Address                                                            City                            State     ZIP

Dealer #                                                             Dealer’s Sales Tax Account Number

Printed Name of Dealer Representative

Signature of Dealer Representative                                                                                    Date

Local Taxes: Unless cities, counties or special districts have       Claiming the Tax Exemption: The dealer should not collect the 
adopted an ordinance or resolution to exempt LEV heavy vehicles,     state sales tax on vehicles that qualify for this exemption, although 
local taxes are due on the purchase or sale of LEV heavy vehicles.   local taxes may still be due. Likewise, the state tax should not be 
Refer to Colorado Sales/Use Tax Rates (DR 1002) to determine if a    collected at the time the vehicle is registered at the county office. 
city or county has allowed this exemption. Home-rule cities are also If any sales tax is paid in error, a Claim for Refund (DR 0137) may 
listed in the DR 1002. Most home-rule cities enact their own sales   be submitted to the state within three years from the purchase 
tax ordinances and collect their own taxes. Contact home-rule cities date to receive a refund of taxes paid in error. Evidence of gross 
directly for their rules regarding sales taxes on heavy vehicles.    vehicle weight rating and EPA certification must be submitted 
                                                                     with the claim to qualify for a refund.