Form 5013 Fillable Certificate to Establish Native American Status and Residence on Arizona Reservation.
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

hereby certify that I am (am not) a hereby certify that I am a Native *CO PURCHASER: *NOTE: If the Co Purchaser of this vehicle is not a Native American residing on an Arizona reservation established for his 127(B)(2) 127(B)(2) AA seller that accepts a certifi AA seller that has reason to believe that the certifi ADDRESS ON RESERVATION (FROM DRIVER S LICENSE): TRIBAL ID CARD NO : ADOR 60 5606 (9/08) American and that I do (do not) reside on the reservation established for my tribe and that theNative American and that I reside on the reservation established for my tribe and that the information on amount equal to any tax penalty or interest illful misuse of this certi cate will subject the purchaser to criminal amount equal to any tax penalty or interest W and completeness of the information provided in the certi cate the purchaser is liable for an amount equal to the and completeness of the information provided in the certifi AND RESIDENCE ON ARIZONA RESERVATION Arizona Department of RevenueCERTIFICATE TO ESTABLISH NATIVE AMERICAN STATUS ARIZONA FORM ARS 42 1ARS 42 1127(B)(2) cate cate Misuse of this certifi cate is true accurate and complete cate is true accurate and complete cationcation Certi CertiCertifi CITY STATE ZIP: NAME OF TRIBE: DateDate ENROLLED MEMBER NAME: DRIVER S LICENSE NO : Exact reproductions and photocopies of this exemption certificate are acceptable for use exemption exemption A fifi cation fificate fificate in good faith and the seller will not be relieved of the burden of proving entitlement to the fificate in good faith will be relieved of the burden of proof and the purchaser fificate is not accurate complete or applicable to the transaction may fificate is true accurate and complete fificate the purchaser is liable for an amount equal to the fificate will subject the purchaser to criminal fificate will subject the purchaser to payment of the ARS 42 5009 FOR PURPOSE OF THE STATUTORY DEDUCTION PROVIDED BY ARS 42 5061(A)(28)(b) I (print full name) I (print full name)I (print full name) hereby certify that I am (am not) a I (print full name)I (print full name) hereby certify that I am a Native information on this certi information on this certiinformation on this certifi may be required to establish the accuracy of the claimed exemption If the purchaser cannot establish the accuracy NATIVE AMERICAN PURCHASER: NativeNative American and that I do (do not) reside on the reservation established for my tribe and that the not accept the certi cate in good faith and the seller will not be relieved of the burden of proving entitlement to the not accept the certifi not accepted the certi Misuse of this certi cate will subject the purchaser to payment of the ARS 42 5009 not accepted the certifi or her tribe the deduction amount shall be limited to 50% of the net sales price of the vehicle penalties of a felony pursuant to penalties of a felony pursuant topenalties of a felony pursuant to ARS 42 1 provides an exemption from state transaction privilege tax for income derived from the sale of a motor vehicle SALE OF MOTOR VEHICLE TO NATIVE AMERICAN RESIDING ON RESERVATION: A R S 42 5061(A)(28)(b) seller that accepts a certi cate in good faith will be relieved of the burden of proof and the purchaserexemption seller that has reason to believe that the certi cate is not accurate complete or applicable to the transaction may Signature of co purchaser Signature of co purchaserSignature of co purchaser Date Signature of purchaser Signature of purchaserSignature of purchaser Date this certi this certithis certifi This exemption does not apply to city privilege tax to [a]n enrolled member of an Indian tribe who resides on the Indian reservation established for that tribe transaction privilege tax penalty and interest which the seller would have been required to pay if the seller had WWillful misuse of this certifi