555 Wright Way
Carson City, NV 89711-0700
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
dmvnv.com
VP154 (Rev. 11-2014) Signatures must be originals. Photocopies are not acceptable. Changes may not be made to this form once it is
signed.
APPLICATION FOR GOVERNMENTAL SERVICES TAX EXEMPTION
(Nevada Tribal Members Residing on Reservation within the Boundaries of Nevada)
Instructions:
This application for exemption must be submitted for each registration period.
Separate applications are required for each vehicle. The application for exemption must be presented at the time of
registration or renewal.
A Tribal Chair of a Nevada Indian Tribe must certify that the applicant meets the eligibility criteria for Governmental Services
Tax exemption.
Eligibility:
The registered owner of the vehicle must be a member of a recognized Nevada tribe.
The vehicle must be located (based) on Nevada tribal land. The physical address for the vehicle registration must be located
on tribal land within the boundaries of the State of Nevada.
Please Print or Type
Vehicle Year _____________________ Make ___________________________________________
Model ___________________________ License Plate Number______________________________
Vehicle Identification Number:
Full Legal Name Last First Middle
Nevada Driver’s License, Identification Card Number, or Date of Birth _________________________________________
Ph
ysical Address
Address City State Zip Code
Mailing Address
Address City State Zip Code
Telephone (optional) ________________________ E-mail (optional) __________________________
I declare under penalty of perjury that the foregoing is true and correct.
Executed on
Date Applicant Signature
I declare under penalty of perjury that the forgoing is true and correct and that the applicant
meets the eligibility requirements listed above.
Tribal Chairman’s Name (Print) Tribal Agency
_______
_________________________________________________________________________________________
Tribal Chairman’s Signature Date
For DMV Use Only Technician Number: _________ Super Trans. Number:____________ Date: _________ Exemption Amount: $ _________
