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AV-10V
AFFIRMATION – Under penalties prescribed by law, I hereby afrm that to the best of my knowledge and belief, the statements and
information on this application are true and correct, and are made for the purpose of exempting the property herein described from
taxation.
Signature of owner or authorized representative Phone Number
Title Date
Name of Owner
Address
Year
Application for Motor Vehicle Exemption
County City or Town
Under the provisions of G. S. 105–330.3 every owner of property claiming exemption or exclusion from property taxes must
demonstrate that the property meets the statuatory requirements for exemption or classication. Claims for exemption or
exclusion of personal property must be led with the assessor of the county in which property is located.
Give complete description of property:
Tag Number Date of Purchase
Make/Model Year Vin Number
Upon what use or purpose do you base this claim for exemption? Charitable Religious Educational
Other
APPROVED YES NO
