Free TC-757 - Utah

Utah State Tax Commission

Affidavit of Out-of-State Delivery
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TC-757 Rev. 12/95

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Complete this form whenever merchandise sold by a Utah vendor is physically delivered by the vendor to a point outside Utah by the vendor or the vendor's employee, as a required part of the sale. This form must be kept by the seller to verify sales tax exemption due to out-of-state delivery. Maintain this form with your records; do not send it to the Tax Commission.

For additional information or assistance, please contact the Utah State Tax Commission, 210 North 1950 West, Salt Lake City, Utah 84134, telephone (801) 297-2200, or 1-800-662-4335 if outside the Salt Lake area.

Sales Tax Exemption Based Upon Out-of-State Delivery
Sale Information Customer's name Seller's invoice number Invoice date

Destination

Customer's telephone number

Section 1 Port of Entry Personnel Certification of Out-of-State Delivery This is to certify that I personally examined the property listed on the seller's invoice. Port of entry signature Date signed Port of entry location Telephone number

X This form must be signed by hand after it is printed. Section 2 Out-of-State Delivery Verification Attach copies of driver's log, fuel purchase receipts, motel and other expenses.

This is to certify that I personally delivered the merchandise described on the seller's invoice to the destination shown above. Delivery signature Date signed Title

X This form must be signed by hand after it is printed. Section 3 Purchaser's Declaration of Out-of-State Acceptance I certify, under the penalties of perjury, that merchandise described on this affidavit was accepted outside the State of Utah. As the purchaser, I understand that if there is a use tax liability on this merchandise, it is to be reported and paid to the seller (if the seller is licensed to collect tax for this state) or directly the Tax Commission. Delivery signature Date signed Title

X This form must be signed by hand after it is printed.

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