2021 Affidavit
Sherry Witt
Knox County Clerk
Post Office Box 1566 Knoxville, TN 37901 (865)215-2385 www.knoxcounty.org/clerk
Affidavit for Wheel Tax Exemption
Motor Vehicle Division Pursuant to Knox County Charter Section 58
-1 & T.C.A. § 5-8-102
Please complete this affidavit, in its entirety, and return it with registration or tag renewal.
Registered Owner Information: (Print exactly as shown on title/registration)
Name: _______________________________________________________________ Date of Birth: ____________________
Address: ________________________________________ City: ________________________ Zip: ____________________
Phone: ____________________
Vehicle Information: Make: __________Year: __________ Model: __________ Current Plate #: ____________________
Basis for Exemption: (Check one)
I certify that the foregoing statements are true and correct to the best of my knowledge and understanding. I
further acknowledge that if the basis for my exemption is in part due to limited income that I have disclosed and
attached hereto any and all sources of income for myself and any other owner of such motor vehicle.
______________________________________________ _______________ _______________________________________
Signature of Applicant Date Clerk Signature
Revised 01/02/2020
Registered owner/owners who is 65 years old or older AND has a combined annual income equal to or less than
$17,170.00 per year. $30.00 EXEMPTION
Documentation required: Driver’s License or birth certificate, AND one (1) of the following for which you qualify: Income Tax
Return – (1040A form) OR Social Security Statement from 2019 (if 1040A income tax form was not filed)
Registered owner/owners who has been certified as totally disabled by the Social Security Administration or the U.S. Dept. of
Veteran’s Affairs AND has a combined annual income equal to or less than $17,170.00 per year. $30.00 EXEMPTION
Documentation required: Driver’s License or birth certificate AND one (1) of the following for which you qualify: __ Award of SSI
(supplemental security income) __ Award of SSD (social security disability) __ Award of Disabled VA
Registered owner/owners of the vehicle who are active duty members of the United States Army, Navy, Marine Corps, Air
Force, and Coast Guard OR members of the Army Reserve, Naval Reserve, Marine Corps Reserve, Air Force Reserve, Coast
Guard Reserve, Army National Guard and Air National Guard who are called to full-time active duty service. $36.00
EXEMPTION Documentation required: Copy of Stationing Orders (must reflect full-time active duty status for reserve/national guard
members)
Registered owner is a veteran who has a 100% permanent total disability from a service-connected cause OR is a former
prisoner of war, as determined by the U.S. Dept. of Veterans Affairs. $36.00 EXEMPTION
Documentation required: DD214 Certificate or other appropriate VA related forms
School bus under contract with Knox County Board of Education. $36.00 EXEMPTION
Documentation required: Certification from Knox County Schools
Registered owner of the vehicle is an active member of a volunteer fire department with at least one (1) year of service shall be
exempt from the vehicle registration tax for one (1) motor vehicle. $36.00 EXEMPTION
Documentation required: Certification of sworn statement from the chief of the fire department to which the person is attached
confirming theperson is an active volunteer firefighter.
Registered owner of the vehicle is an active member of the Volunteer Rescue Squad who has at least one (1) year of service shall
be exempt from the vehicle registration tax for one (1) motor vehicle. $36.00 EXEMPTION
Documentation required: Certification of sworn statement from the squad chief confirming the person is an active volunteer
member.
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