Form 71A101 "Motor Vehicle Usage Tax Multi-Purpose Form" - Kentucky

What Is Form 71A101?

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

Form Details:

  • Released on May 1, 2016;
  • The latest edition provided by the Kentucky Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form 71A101 by clicking the link below or browse more documents and templates provided by the Kentucky Department of Revenue.

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Download Form 71A101 "Motor Vehicle Usage Tax Multi-Purpose Form" - Kentucky

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71A101 (05-16)
MOTOR VEHICLE USAGE TAX
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
MULTI-PURPOSE FORM
SECTION A
Date__________________
Plate Number _________________________ Title Number ________________________________________________
Vehicle Identification Number (VIN) __________________________________________________________________
Registration County _________________________ Year ______________ Make _____________ Model __________
Registration Applicant’s Name _______________________________________________________________________
(Signature required in applicable section of form for proper completion.)
The Department of Revenue may deny the exemption claimed if form is incomplete or requested documentation is not submitted.
Applicant(s) will be liable for any additional tax, plus applicable penalty and interest.
SECTION B
 
 
 
Spouse/Spouse
(Step) Parent/(Step) Child
Grandparent/Grandchild
I, __________________,_________________________ , am the __________________ of __________________________ .
R
(Printed Name)
(Signature)
(Relationship)
(Name)
E
L
I, __________________,_________________________ , am the __________________ of __________________________ .
(Printed Name)
(Signature)
(Relationship)
(Name)
A
T
I, __________________,________________________ , am the ___________________ of __________________________ .
I
(Printed Name)
(Signature)
(Relationship)
(Name)
O
N
I, __________________,________________________ , am the ___________________ of __________________________ .
(Printed Name)
(Signature)
(Relationship)
(Name)
All Persons Involved in a Multi-line Transfer Must be Kentucky Residents.
SECTION C
Under penalties of perjury, I __________________________________________ , _______________________________ ,
(Name)
(Grade)
___________________________ , and am stationed in Kentucky at ______________________________ on active
(Service Number)
(Military Base)
military duty under orders of the United States Government.
M
 
Kentucky Resident
I
Documentation showing duty in the Commonwealth under U. S. Government orders must be attached.
L
I
 
Non-resident military
T
Copy of Current Leave Earning Statement (less than 120 days old) must be attached.
A
R
Y
(Signature of Serviceperson Claiming Exemption)
(Date)
(Applicable to military personnel stationed in Kentucky who purchase a vehicle from Kentucky dealers only.)
71A101 (05-16)
MOTOR VEHICLE USAGE TAX
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
MULTI-PURPOSE FORM
SECTION A
Date__________________
Plate Number _________________________ Title Number ________________________________________________
Vehicle Identification Number (VIN) __________________________________________________________________
Registration County _________________________ Year ______________ Make _____________ Model __________
Registration Applicant’s Name _______________________________________________________________________
(Signature required in applicable section of form for proper completion.)
The Department of Revenue may deny the exemption claimed if form is incomplete or requested documentation is not submitted.
Applicant(s) will be liable for any additional tax, plus applicable penalty and interest.
SECTION B
 
 
 
Spouse/Spouse
(Step) Parent/(Step) Child
Grandparent/Grandchild
I, __________________,_________________________ , am the __________________ of __________________________ .
R
(Printed Name)
(Signature)
(Relationship)
(Name)
E
L
I, __________________,_________________________ , am the __________________ of __________________________ .
(Printed Name)
(Signature)
(Relationship)
(Name)
A
T
I, __________________,________________________ , am the ___________________ of __________________________ .
I
(Printed Name)
(Signature)
(Relationship)
(Name)
O
N
I, __________________,________________________ , am the ___________________ of __________________________ .
(Printed Name)
(Signature)
(Relationship)
(Name)
All Persons Involved in a Multi-line Transfer Must be Kentucky Residents.
SECTION C
Under penalties of perjury, I __________________________________________ , _______________________________ ,
(Name)
(Grade)
___________________________ , and am stationed in Kentucky at ______________________________ on active
(Service Number)
(Military Base)
military duty under orders of the United States Government.
M
 
Kentucky Resident
I
Documentation showing duty in the Commonwealth under U. S. Government orders must be attached.
L
I
 
Non-resident military
T
Copy of Current Leave Earning Statement (less than 120 days old) must be attached.
A
R
Y
(Signature of Serviceperson Claiming Exemption)
(Date)
(Applicable to military personnel stationed in Kentucky who purchase a vehicle from Kentucky dealers only.)
KRS 190.990(5) provides that any person who willfully and fraudulently submits a false statement as to the
total and actual consideration paid for a motor vehicle is guilty of a Class D felony and subject to a fine of not
less than $2,000 per offense.
SECTION D
Complete this section for all transactions involving modified vehicles and those to which major equipment
has been added, if not using Form 71A100 and or TC 96-182. This form will not be accepted without proper
M
documentation (contract, bill of sale, front and back of cancelled check, etc.).
O
When using this form, taxable value of the modified, customized or converted vehicle shall not be less than the
D
retail value shown in the price reference manual for the vehicle without the modification.
I
F
I
 
Box/Flatbed
Bus/Limousine
E
Tank/Sprayer
Bucket/Lift/Cherry Picker
D
Packer/Garbage
Drill Body/Winch
 
Custom Truck/Van
  Ambulance/Hearse
O
 
Dump/Mixer
Other*
R
Wrecker/Rollback
C
O
Purchase Price $_______________________
N
If “Other, ” specify _______________________________________ Revenue Code Number _______________________
V
E
*Those vehicles not listed in the prescribed reference manual, and those not modified, customized or
R
converted, must have a Revenue Code Number accompanying this form.
T
E
D
(Signature of Person Claiming Exemption)
(Date)
SECTION E
H
The portion of the retail price attributable to equipment or adaptive devices placed on new motor vehicles to
E
A
facilitate or accommodate handicapped persons is exempt from motor vehicle usage tax. Documentation of
Q
N
amount paid for such equipment or adaptive devices must be submitted with this certification.
U
D
I
I
P
Price Without Trade or Before Trade $ _________________________________________________________________
C
M
A
E
P
Portion of Price Attributable to Handicapped Equipment or Adaptive Devices $ __________________________
N
P
T
E
D
(Signature of Person Claiming Exemption)
(Date)
Please Note: For those vehicles whose values are not found in the prescribed price reference manuals,
contact the Motor Vehicle Usage Tax Section at (502) 564-4455.
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