Military Tax Exemption Form by bwf17633

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									                                                                                SPECIAL MILITARY EXEMPTION

96-0240 R03/09   www.azdot.gov                                                                       Clear



This form is used to apply for an exemption from the payment of vehicle license tax and registration fees for certain
members of the US Armed Forces. This exemption applies to no more than two vehicles and only from the date of
deployment until one year after discharge. Each vehicle requires a separate exemption form. A spouse, surviving
spouse or legally designated representative may request an exemption on behalf of an owner/lessee serving on active
duty, or an owner/lessee who died while serving on active duty or remains listed as missing in action.


Vehicle Identification Number                                   Year   Make                              Month/Year Registration Expires




Check the box for the qualifications that apply to you:

   I am/was a member of the US Armed Forces regular component, reserve component or National Guard, and
   I served on active military duty outside of Arizona in support of a worldwide contingency operation of the
   US Armed Forces, and
   I am an Arizona resident and the owner/lessee of the vehicle described above.


   I am/was a member of the Arizona National Guard regular or reserve component, and
   I served in Operations Enduring Freedom or Noble Eagle, and
   I am an Arizona resident and the owner/lessee of the vehicle described above.


Service Information
Name (first, middle, last, suffix)                                                                     Military Rank


Military Service Number                        Branch of Service                              Unit Designation


Deployment Date                                Discharge Date (if applicable)                 Release Date From Active Duty*


                                                    * If surviving spouse or personal representative, enter the date of death
                                                        of the vehicle owner/lessee or date listed as missing in action.


I certify that the statements above are true and complete and
that I meet all qualifications for the exemption indicated.
Owner/Lessee Signature




                                                                                 Notary or MVD Agent Signature
                                        Acknowledged before me this date.

                                        Date                       County                State   Commission Expires




I certify that the Service Information above is true, complete and correct.
Signature of Commanding Officer or Staff Judge Advocate                          Date

								
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