Free DR-41C - Florida

Dealer's Sales Tax Statement ­ Boats

DR-41C R. 04/01

Date: ________________ I hereby certify that the sales tax due under Chapter 212, Florida Statutes, has been paid by the purchaser on the boat described herein: Purchaser's Name: ___________________________________________________________________________________________ Address: ___________________________________________________________________________________________________ City: _________________________________ State: ________ ZIP: ________________ Phone: ( ) _______________________ Previous Owner's Name: _______________________________________________________________________________________ Address: ___________________________________________________________________________________________________ City: _________________________________ State: ________ ZIP: ________________ Phone: ( ) _______________________ Description-Make: _________________________________ Model: ___________________ Hull Number: _____________________ State Registration and/or Documentation Number: __________________________________________________________________ Length: ________________ Beam: _______________________ Vessel Name: ___________________________________________ Type (check one): Inboard Outboard Sail Other Date Purchased: ___________________ Purchase Price: $ _____________________ Tax Collected: $ ________________________ Dealer's Name: ______________________________________________________________________________________________ Address: ___________________________________________________________________________________________________ City: _________________________________ State: ________ ZIP: ________________ Phone: ( ) _______________________ Certificate of Registration Number: _______________________________________________________________________________ Signature: __________________________________________________________________________________________________ This form is not valid unless completed in its entirety, signed by selling dealer, and the dealer's sales tax certificate of registration number shown.