Wyoming Dept of Revenue 
                      Sales and Use Tax Exemption Affidavit                     Excise Tax Division 
                                                                                122 W. 25th Street, 3E 
                     for Non Resident Purchase of a Motor Vehicle               Cheyenne, WY 82002-0110 
                                                                                                               
                          for Use Outside of Wyoming                            Phone:  307-777-5200 
                                     W.S. 39-15-105(ix)(B)                      Fax:  307-777-3632 
 
This sales tax exemption is only valid if all names and addresses are complete and the form is signed by the 
purchaser and provided at the time of purchase.  
 
Type of Vehicle (i.e. motorcycle, snow mobile,   Year      Make 
ATV, etc.)                                                 
                                                           
 Model                   Style or Trim                     Vehicle Identification Number (VIN) 
                                                            
Non-Resident Purchaser                                     
                                                    Dealer
 Name                                                Name 
                                                      
 Address                                             Address 
                                                      
 City        State       ZIP Code                    City                State ZIP Code 
                                                                                
Driver’s License Number State of Licensure 
                                                   This form is invalid unless the Purchaser's Out of 
                                                    
                                                    State Driver's License information is provided. 
                         
USE THIS FORM to apply for an exemption of sales tax on the purchase of a vehicle required to be titled 
under W.S. 31-2-101. 
This exemption is only valid if the vehicle is: 
 1.   removed from the State of Wyoming within thirty (30) days and 
 2.  the vehicle is purchased by a non-resident of the State of Wyoming 
                                                            
 Non-Resident Purchaser's Signature                        Date Signed 
                                                           
I declare under penalty of perjury/false swearing, that the above information is true and complete and I 
provide this information knowing that a false claim with intent to defraud is a felony punishable by 
imprisonment for not more than two (2) years, a fine of not more than two thousand dollars ($2,000), or both.  
                                                             
DEALERS: Keep this form for your records for a minimum of three years to verify the sales tax 
exemption. Do not send it to the Wyoming Department of Revenue.  
  
ETS Form 105a                                                                   Rev. 09/01/2018