(CAG & GD) Sierra Auction - Arizona - Native American who resides on Arizona reservation (Form 5013)

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

1. You are a Native American who resides on a reservation within the state of Arizona.

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

3. You are having the vehicle delivered via a Logistics Carrier to your address that is located on the reservation (from driver's license).
Your Account Username:*
Note: This is what you use to sign into allsurplus.com and/or GovDeals.com. This is NOT your first name and last name.
Your Email:*
The LOT # that you are seeking tax exemption for:*
Example: 25917-1 is 25917-001
Name of Tribe / Tribal Government:*
Your Enrolled Member Name:*
Your Tribal Card Number:*
Please provide a copy of your Tribal Card:*

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Your Driver's License Number:*
Please provide a copy of your driver's license:*

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Your Address on reservation (from driver's license):*

Street Address

Street Address Line 2

CityState

Zip Code
Please provide a copy of the Bill of Lading (BOL). Your logistics carrier will provide you a copy.*

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Misuse of this certificate will subject you, the purchaser, to payment of the A.R.S. 42-5009 amount equal to any tax, penalty or interest.

Willful miuse of this certificate will subject you, the purchaser, to criminal penalties of a felony pursuant to A.R.S. 42-1127(B)(2).
Signature*

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