(CAG & GD) Sierra Auction - Arizona - Resident of foreign country (Form 5012)

Only complete this form if you meet the all of the following criteria:

1. You are based outside of the United States of America

2. You are seeking sales tax exemption for a vehicle that was purchased within the state of Arizona from the seller "Sierra Auction."

1. I am a resident of a state in the United States:

TRUEFALSE

2. I do not have a valid passport or other government issued travel identification issued by the Country in which I reside:

TRUEFALSE

Are you Nonresident of Arizona who is a student that is enrolled at an Arizona Educational Institution that is paying out-of-state tuition fees?

3. I am engaged in a trade, profession or occupation in Arizona in other than agricultural work or temporary seasonal work:

TRUEFALSE

4. I am employed in the State of Arizona:

TRUEFALSE

5. I have placed my children in an Arizona public school (K-12) without payment of nonresident tuition:

TRUEFALSE

6. I attend an Arizona educational institution and pay resident status tuition rates:

TRUEFALSE

7. I am an individual, partnership, company, firm, corporation or association that maintains a main office, a branch office or warehouse facilities in Arizona and operates a motor vehicle in Arizona:

TRUEFALSE

8. I am an individual, partnership, company, firm, corporation or association that operates a motor vehicle in intrastate transportation, for other than seasonal agricultural work:

TRUEFALSE

9. I am purchasing this vehicle for transfer to a resident of Arizona:

TRUEFALSE

10. I have a valid driver's license issued by a state in the United States of America:

TRUEFALSE

11. I am registered to vote in the State of Arizona:

TRUEFALSE

12. I file Resident status income tax returns, or business tax returns in the State of Arizona:

TRUEFALSE

13. My auto insurance policy is issued under the laws of Arizona (other than temporary 90-day license from Arizona Motor Vehicle Division):

TRUEFALSE

You are ineligible for sales tax exemption.

The sales tax must be paid directly to Liquidity Services.

Please provide a current, valid copy of your driver's license, indicating an address outside of Arizona:

Please provide a copy of your current student identification card:

Driver's License Number:

Country that issued your driver's license:

Expiration date of your driver's license:

What documentation are you providing to prove that the asset is leaving Arizona?

(90 day) What is the permit number?

Please provide a copy of the 90-day permit

Please provide a copy of the Bill of Lading (BOL):

Your Account Username:

Note: This is what you use to sign into govdeals.com and/or allsurplus.com. This is NOT your first name and last name.

Your Full Name:

Your initials

Initials for 3 and 4 (if applicable)

Your Phone Number:

Country CodeArea CodePhone Number

Your Auto Insurance Company:

Your Auto Insurance Policy Number:

Your Email:

Do you own a company?

Your Company's Name:

Your Company's Address:

Street Address

Street Address Line 2

CityState / Province

Zip CodeCountry

Your Company's Tax ID Number:

The LOT # that you are seeking tax exemption for:

Example: 25917-1 is 25917-001

Winning bid amount:

Year:

Make:

Model:

VIN:

Signature

Date:

Date