EXEMPTION CERTIFICATE
TIRE FEE
The undersigned hereby certifies that the new tire(s) listed on the attached sales invoice or purchase order will be used exclusively on the following type of vehicle or equipment, which is excluded from the definition of "motor vehicle, " as provided by paragraph 12A-12.001(2)(a), F.A.C.:
_____ Farm tractor
_____ Farm trailer
_____ Other (specify) _____
I understand that if I fraudulently issue this certificate to evade the payment of the fee imposed on a new tire I will be liable for payment of the fee, plus a penalty of 200% of the fee, and may be subject to conviction of a third degree felony.
Under the penalties of perjury, I declare that I have read the foregoing Exemption Certificate and the facts stated in it are true.
Purchaser's Name _______________________
By (Purchaser's Signature) ________________
Date _______________
Fla. Admin. Code Ann. R. 12A-12.001
Rulemaking Authority 212.07(1)(b), 212.18(2), 213.06(1), 403.718(3)(b) FS. Law Implemented 212.07(1)(b), 212.12, 212.17(1)(a), 403.717, 403.718 FS.
New 1-2-89, Amended 10-16-89, 12-16-91, 3-20-96, 6-19-01, 10-29-13.