Form ST-137AC State Form (7-06) Indiana Department of Revenue Affidavit of Exemption by a NONRESIDENT for Out-of-State Delivery of Aircraft to be Registered and/or Titled Outside the State of Indiana Purchaser's Information and Affidavit Social Security # or Federal ID # Name of Purchaser Address C ity S ta te Zip Code I hereby certify under penalty of perjury that I am not a resident of the State of Indiana and that the Aircraft described below will be removed from the State of Indiana within 30 days of delivery and that the aircraft will be registered/titled in the state/country of _____________________. Printed Name and Title Purc ha s e r's Signa ture Date Description of Aircraft Purchase Year Total Sale Price $ (plus options/dealer prep) Make Model Trade-In Allowance (Aircraft only) Net Sale Price Serial Number FAA Number N $ $ Description of Aircraft Trade-in FAA Number Aircraft Make & Model Aircraft Serial Number N Seller's Information and Affidavit Name of Seller Address For more information about this form contact the Department at: (317) 232-1497 City State, Zip Code Indiana Retail Merchant Number Dealer # I certify under the penalty of perjury that the information contained in this form is true, correct and complete to the best of my knowledge and belief. S e lle r's S igna ture Printed Name and Title Instructions: The purchaser's signature, Social Security Number or Federal ID Number, the name of the state where the aircraft purchased is being taken and the seller's signature must be shown on this form ST-137AC or the sales tax exemption is invalid. The seller will be held liable for sales tax on invalid exemptions. Also, this Certification of Exemption for Out-of-State Delivery must be properly completed and executed in duplicate. A copy is to be retained by the seller. The seller must mail the original copy within 30 days to: Date Indiana Department of Revenue P.O. Box 644 Indianapolis, IN 46206-0644 American LegalNet, Inc. www.FormsWorkflow.com