STATE OF NEW JERSEY
  ST-10V                                      DEPARTMENT OF THE TREASURY
SUPPLEMENT  1                                 DIVISION OF TAXATION
   (11-99, R-5)
               VESSEL DEALER SALES AND USE TAX EXEMPTION REPORT
                                              FOR A FOREIGN CORPORATION
                                         (See Reverse Side for Instructions and Privacy Act Notification)
I
   Name                                                                       Telephone                  Federal Identification Number
   _______________________________________________________________________________________________________________________
   Address (Number and Street or Rural Route)                                                            State of Incorporation
   _______________________________________________________________________________________________________________________
   City, Town or Post Office and State                                        Zip Code                   Date of Incorporation
   _______________________________________________________________________________________________________________________
   (a) Does this corporation have a registered agent? . . . . .       ¨ Yes   ¨ No
       Name                                                           Address                            Telephone
       If yes, ______________________________________________________________________________________________________________
   (b) Is the stock of this corporation publicly held?  . . . . . . . ¨ Yes   ¨ No
       Name of Exchange                                                                      Symbol
       If yes, ______________________________________________________________________________________________________________
       Number of shares outstanding ________________________________
   (c) Is the stock of this corporation closely held?  . . . . . . .  ¨ No      Yes - Number of shares ____________________________
       If yes, Part IV must be completed.
II

   (a) Principal type of business ______________________________________________________________________________________________
   (b) Location of principal office ______________________________________________________________________________________________
   (c) Does this corporation have an office in New Jersey? . . . . . .  ¨ No    ¨ Yes - Address ____________________________________________
   (d) Does this corporation:
       1. Own or lease real property?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ¨ Yes ¨ No
       2. Own or lease tangible or intangible personal property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               ¨ Yes ¨ No
       3. Employ any other assets in a business, trade, profession or occupation?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                         ¨ Yes ¨ No
       4. Own merchandise or other property for sale?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .           ¨ Yes ¨ No
       5. Own assets which are leased to others?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .        ¨ Yes ¨ No
       6. Perform any construction, erection, installation or repair work or other services?  . . . . . . . . . . . . . . . . . . . . . . . . . .                        ¨ Yes ¨ No
       7. Receive payments from persons for the sale of services or property?  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                       ¨ Yes ¨ No
   (e) Do any of the above activities take place in New Jersey? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .              ¨ Yes ¨ No
       If yes, state details.  (Use separate sheet if necessary.) _______________________________________________________________________
       ___________________________________________________________________________________________________________________
       ___________________________________________________________________________________________________________________
III
   Names of Principal Officers                Title and Social Security Number               Address                                                                           Telephone
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
IV     To be completed only by a corporation answering “Yes” to question (c), Part I.
   Names of Major Stockholders                Address                                        Telephone   Social Security Number
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
   _______________________________________________________________________________________________________________________
                             CERTIFICATION OF AN AUTHORIZED OFFICER OF THE CORPORATION
I hereby certify that this report, including any accompanying rider, is to the best of my knowledge a true, correct and complete report.

____________________________________________________________________________________________________________________________
        Signature of Officer                                                  Official Title                                                                               Date
                                       THIS FORM MAY BE REPRODUCED WITHOUT PRIOR AUTHORITY

                         PRIVACY ACT NOTIFICATION

The Federal Privacy Act of 1974 requires all agencies requesting information to inform individuals from
who it seeks information why the request is being made and how the information is being used.

Your social security number is used primarily to account for and give credit for tax payments.  It is also
used in the administration and enforcement of all tax laws for which the Division of Taxation has statutory
responsibility.

                         INSTRUCTIONS FOR DEALER

This supplement must be completed and attached to FORM ST-10V whenever a vessel is purchased by
a foreign corporation which claims exemption from sales tax under N.J.S.A. 54:32B-10 of the New Jersey
Sales and Use Tax Act.

a. Fill out report in duplicate.
b. Print or type report.
c. Complete all information.  If not applicable write “NONE”.
d. Do not fold.
e. Retain copy for your files.
f. Send original attached to Form ST-10V to:
               New Jersey Division of Taxation
               Motor Vehicle Casual Sales Section
               PO Box 267
               Trenton, NJ  08695-0267

ST-10V  Supplement 1                                                                         Page 2