Sworn Affidavit Form
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Sworn Affidavit Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Sworn Affidavit Form, 7669, Indiana Statewide, Department Of Revenue
State Form 7669
(R2 / 7-07)
Indiana Department of Revenue
SWORN AFFIDAVIT FORM
• Sworn Affidavit Form signed by seller is due at time of Application for Registration.
• For assistance call (317)232-1497
• Mail Sworn Affidavit to: Indiana Department of Revenue
Tax Administration/Support-Aeronautics
P.O. Box 644
Indianapolis, Indiana 46206-0644
SELLER:
Name (Last, First, Middle Initial)
Street Address
City
State
Zip Code
State
Zip Code
PURCHASER:
Name (Last, First, Middle Initial)
Street Address
City
DESCRIPTION OF AIRCRAFT PURCHASE:
FAA Number
N
Year of Mfg.
Serial Number
Aircraft Make
Date of Purchase
(Month, Day, Year)
Aircraft Model
DESCRIPTION OF TRADE: (must be an aircraft or aircraft parts):
FAA Number
N
Year of Mfg.
Aircraft Make
Serial Number
Aircraft Model
SUMMARY:
Aircraft Selling Price
$
Subtract Aircraft Trade Value
$
Amount Subject to Sales/Use Tax
$
I hereby verify, under penalty of perjury, that the total price paid for the above described aircraft represents the true amount collected
for the sale of the aircraft. This statement is made for the purpose of providing a value for use by the Indiana Department of Revenue
in determining the purchaser’s Sales/Use Tax.
Date (Month, Day, Year) _________________
Signature of Seller ______________________________________________
Print Name of Seller _____________________________________________
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