Form ST-A-124 "Affidavit for Purchase of Adaptive Equipment" - Maine

What Is Form ST-A-124?

This is a legal form that was released by the Maine Department of Administrative and Financial Services - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the Maine Department of Administrative and Financial Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ST-A-124 by clicking the link below or browse more documents and templates provided by the Maine Department of Administrative and Financial Services.

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Download Form ST-A-124 "Affidavit for Purchase of Adaptive Equipment" - Maine

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MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
Affidavit For Purchase of Adaptive Equipment
I hereby certify the equipment purchased pursuant to this affidavit will be installed in or
on a motor vehicle to make that vehicle operable or accessible by a person with a disability.
The person with a disability has been issued a valid disability plate or placard issued by
the Secretary of State pursuant to Title 29-A, section 521.
Plate/placard number
Expiration date
I further certify that I assume full liability for payment to the State of Maine of any use
taxes, together with penalties and interest that may later be determined to be due on any
purchases covered by this affidavit because of a taxable use of the property.
Description of property:
______________________________________________________
Purchaser
_______________________________________________________
Address
_______________________________________________________
_______________________________________________________
Date
_______________________________________________________
ST-A-124
7-1-2014
MAINE REVENUE SERVICES
SALES, FUEL & SPECIAL TAX DIVISION
Affidavit For Purchase of Adaptive Equipment
I hereby certify the equipment purchased pursuant to this affidavit will be installed in or
on a motor vehicle to make that vehicle operable or accessible by a person with a disability.
The person with a disability has been issued a valid disability plate or placard issued by
the Secretary of State pursuant to Title 29-A, section 521.
Plate/placard number
Expiration date
I further certify that I assume full liability for payment to the State of Maine of any use
taxes, together with penalties and interest that may later be determined to be due on any
purchases covered by this affidavit because of a taxable use of the property.
Description of property:
______________________________________________________
Purchaser
_______________________________________________________
Address
_______________________________________________________
_______________________________________________________
Date
_______________________________________________________
ST-A-124
7-1-2014