Free DR-42B - Florida

Ownership Declaration and Sales and Use Tax Report of Vessel Purchase

DR-42B R. 07/02

Name of vessel Name of purchaser Address

Year

Make

Model

USCG documentation or state reg. no. Daytime telephone number (include area code) State ZIP

Florida sales tax registration number City

The vessel described above was purchased from (Name of seller, dealer, or broker) Address City State ZIP

Delivery was accepted at_________________________________________________on the________ day of __________________ 20________.
Name of marina, boat yard, etc.

Address Present location of vessel Address

City

State

ZIP

City

State

ZIP

Indicate the total purchase price, including any unpaid balance due seller, bank, or finance company. Include the total consideration valued in money, whether paid in money or otherwise.
Total purchase price .......................................................................... Less: Trade-in (if applicable) ................................................. Net purchase price ............................................................................ Florida tax due (6%) .......................................................................... Florida discretionary sales surtax ...................................................... Less: Florida tax paid (attach copy of receipt) ...................... Less: Taxes lawfully imposed and paid to another state ....... (attach copy of receipt) Balance due ..................................................................................... Penalty (10% per month, up to 50%) ................................................ Interest .............................................................................................. TOTAL DUE $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________ $ _________________________________________________

I hereby affirm under penalty of perjury that all of the above statements are true and correct to the best of my knowledge and belief. Sworn and subscribed to before me this______________day of ____________________________________________
Notary Public

, 20_____

____________________________________________
Signature of purchaser

____________________________________________
Date THIS DOCUMENT MUST BE RETURNED TO THE DEPARTMENT OF REVENUE WITHIN 15 DAYS FROM RECEIPT. A COPY OF THE BILL OF SALE AND OTHER DOCUMENTATION WHICH EVIDENCES OWNERSHIP AND ACTUAL SELLING PRICE MUST BE ATTACHED.

____________________________________________
Date RETURN TO: ENFORCEMENT OPERATIONS DEPARTMENT OF REVENUE POST OFFICE BOX 6417 TALLAHASSEE, FLORIDA 32314-6417