Dealership Name

Dealership Address

Dealer #
FEIN #
Monthly Report for

Signature

Total New Sales

Total Used Sales
Total Wholesale Sales
Total Salvage Sales
Total Taxable Sales
Phone

By my signature, I swear or affirm that this is a true and correct statement. I am aware that law provides severe penalties for making false statements.

Purchase
Date

Purchaser Name
Purchaser Address

Vehicle Year/Make
VIN

Odometer
Reading

Net Taxable
Selling Price

Sales Tax
Collected

Sales Types: N = New, U = Used, S = Salvage, W = Wholesale, E = Exempt

Dealership Name
Dealership Address

Dealer #
FEIN #
Monthly Report for

Signature

Total New Sales

Total Used Sales
Total Wholesale Sales
Total Salvage Sales
Total Taxable Sales
Phone

By my signature, I swear or affirm that this is a true and correct statement. I am aware that law provides severe penalties for making false statements.

Purchase
Date

Purchaser Name
Purchaser Address

Vehicle Year/Make
VIN

Odometer
Reading

Net Taxable
Selling Price

Sales Tax
Collected

Dealership Name
Dealership Address

Dealer #
FEIN #
Monthly Report for

Signature

Total New Sales

Total Used Sales
Total Wholesale Sales
Total Salvage Sales
Total Taxable Sales
Phone

By my signature, I swear or affirm that this is a true and correct statement. I am aware that law provides severe penalties for making false statements.

Purchase
Date

Purchaser Name
Purchaser Address

Vehicle Year/Make
VIN

Odometer
Reading

Net Taxable
Selling Price

Sales Tax
Collected

(excludes wholesale & ST8B)

Temporary
Permit #

ST-8 #
or
ST-8B

Sale Type
(N/U/S/W)
etc

(excludes wholesale & ST8B)

Temporary
Permit #

ST-8 #
or
ST-8B

Sale Type
(N/U/S/W)
etc

(excludes wholesale & ST8B)

Temporary
Permit #

ST-8 #
or
ST-8B

Sale Type
(N/U/S/W)
etc