Form AE-1 SF 46815 (R3/5-10) Indiana Department of Revenue Based Out of State Certificate of Exemption For Aircraft Name of Aircraft Owner Address City State Zip Code I hereby certify under the penalty of perjury that the aircraft described below is exempt from INDIANA AIRCRAFT REGISTRATION AND TAX because the aircraft will be based immediately in the State of ______________________ to be licensed or registered for use in that State, and will not at any time be based in the State of Indiana, as provided for in I.C. 6-6-6-.5-9(a)(6). I hereby authorize the Indiana Department of Revenue to forward a copy of this affidavit to the Revenue Department of such State. Aircraft Owner’s Signature Date Aircraft Owner’s Printed Name BASE LOCATION OF AIRCRAFT DOCUMENTS REQUIRED (attach one from each section) Section A Hangar Lease Agreement Hangar Rent Receipts (Minimum 11 months) Letter from Airport Manager Section B Paid Sales Tax Receipt Current State Registration AIRCRAFT DESCRIPTION FAA N Number Aircraft year of Mfg. Serial Number Aircraft Make Aircraft Model Aircraft Purchase Date INSTRUCTIONS: Based Out of State Certificate of Exemption must be completed and returned with required documents to: Indiana Department of Revenue, Special Tax – Aeronautics, P.O. Box 644, Indianapolis, IN 46241-0644 within thirty (30) days after the purchase date. Each calendar year thereafter, Based Out of State Certificate of Exemption must be filed on or before the last day of February. American LegalNet, Inc. www.FormsWorkFlow.com