Vehicle Identification Number
Year
Make
Plate Number
Tribe
Reservation
Reservation Address
I certify that this address is located on the
Reservation listed above and that I reside there.
I claim exemption from vehic
le license tax for this vehicle as provided in the Constitution of Arizona, Article 20,
Paragraph 5 and certify that I am an enrolled member of the tribe and reside within the boundaries of the
reservation described above and authorize the tribe enrollment
office to release any information regarding this
certification.
Owner Name (first, middle, last, suffix)
Owner Signature
Census Number
Owner Name (first, middle, last, suffix)
Owner Signature
Census Number
Acknowledged before me this date.
Notary or MVD Agent Signature
Date
County
State
Commission Expires
VEHICLE LICENSE TAX
TRIBAL EXEMPTION
48-7701 R07/15 azdot.gov
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