As purchaser of a Year ______ Make ________ Body Style ______ VIN ____________________________________ Fuel____
I, ________________________________________ certify that I qualify for the Highway Use Tax exemption based on one of
the following reasons:
a. By a retailer and is to be transferred back to the retailer within 300 days after the transfer to the
local board.
To a handicapped person from the Department of Health and Human Services after the vehicle has been
To a volunteer fire department or volunteer rescue squad that is not part of a unit of local government,
has no more than two paid employees, and is exempt from State income tax under G.S. 105-130.11,
a. A fire truck, a pump truck, a tanker truck, or a ladder truck used to suppress fire.
Check Applicable Box
Under penalty of law, I certify the above declaration is true.
OWNER'S SIGNATURE ________________________________________________________________________________________________
OWNER'S ADDRESS___________________________________________________________________________________________________
Date _________________________ County ________________________ State _________________________
I certify that the following person(s) ______________________________________________________________personally appeared before
me this day, each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated therein and in the
capacity indicated.
Notary Signature _______________________________________________________
Notary Printed or Typed Name ____________________________________________
My Commission Expires __________________________________________________
(In accordance with US Revenue Code (IRC) and NC General Statute 105-187.6)
b. A four-wheel drive vehicle intended to be mounted with a water tank and hose and used for
To a co-owner when there is no compensation for the transfer.
Will or Intestacy when no compensation has been paid to the estate.
Gift between spouse and spouse.
Gift between parent and child.
Gift between stepparent and stepchild.
By distribution of marital property due to separation or divorce.
To a local board of education for use in the driver education program of a public school when the motor
vehicle is transferred:
Repossessor applying for title in their name when lien has been properly recorded.
Merger of corporations or name changes (consult title manual for variations).
Transfer to separate entity where no gain or loss is recognized under US Code section 351 or 721 of the US IRC.
Transfer to non-separate entity or entity whose existence is disregarded under US IRC.
equipped by the Department for use by the handicapped.
when the motor vehicle is one of the following:
(Rev. 02/2016)
Cherokee Indian living on the reservation (submit copy of Cherokee ID card).
To a State agency from a unit of local government, volunteer fire department, or volunteer rescue squad
to enable the State agency to transfer the vehicle to another unit of local government, volunteer
fire department, or volunteer rescue squad.
To a revocable trust from an owner who is the sole beneficiary of the trust.
Even Trades (computer schedule will be used to determine value of each vehicle for casual sales). Partial
credits pursuant to G.S. 105-187.7.
North Carolina Division of Motor Vehicles
Highway Use Tax Exemption Certification
(In accordance with US C
ode 351 and 721 and NC General Statute 105-187.6)
forest fire fighting.
c. An emergency services vehicle.
b. By a local board of education.