Free DR-99A - Florida

DR-99A R. 05/99

Affidavit for Private Casual Sale of a Motor Vehicle
Warning: Section 212.05(1)(a)1.b., F.S. provides in part: ". . . Any party to such sale who reports a sales price less than the actual sales price is guilty of a misdemeanor of the first degree, punishable as provided in s. 775.082 or s. 775.083. The department shall collect . . . from such party any delinquent sales taxes. In addition, such party shall pay any tax due and any penalty and interest assessed plus a penalty equal to twice the amount of additional tax owed. . . . " Seller's Affidavit
STATE OF _____________________________________________________ COUNTY OF ______________________________________________________ Before me this day personally appeared _______________________________________________________ , who being first duly sworn, deposes and says: As seller of the vehicle described as a _________________________________________________________________________________________________________________________________ (MAKE) (MODEL) (VEHICLE IDENTIFICATION NUMBER) I swear or affirm that the total selling price of said vehicle, including any unpaid balance due, was $ _____________________. I understand that giving a false statement can subject me to penalty equal to twice the amount of the additional tax owed. Sworn to (or affirmed) and subscribed before me this _____________ day of __________, A.D., _________.
(Day of Month) (Month) (Year)

______________________________________________
(Signature of Seller/Affiant) Personally Known ______________________ Or Produced Identification _______________________ Type of Identification Produced ______________________

_______________________________________________
(Signature of Notary)

_______________________________________________
Print, Type or Stamp Name of Notary

Purchaser's Affidavit
STATE OF _____________________________________________________ COUNTY OF ______________________________________________________ Before me this day personally appeared _______________________________________________________ , who being first duly sworn, deposes and says: As purchaser of the vehicle described as a _________________________________________________________________________________________________________________________________ (MAKE) (MODEL) (VEHICLE IDENTIFICATION NUMBER) I swear or affirm that the total purchase price of said vehicle, including any unpaid balance due, was $ _____________________. I understand that giving a false statement can subject me to penalty equal to twice the amount of the additional tax owed. Sworn to (or affirmed) and subscribed before me this _____________ day of __________, A.D., _________.
(Day of Month) (Month) (Year)

______________________________________________
(Signature of Purchaser/Affiant) Personally Known ______________________ Or Produced Identification _______________________ Type of Identification Produced ______________________

_______________________________________________
(Signature of Notary)

_______________________________________________
Print, Type or Stamp Name of Notary

This transaction is subject to review by the Department of Revenue