APPLICATION AND AFFIDAVIT OF NONRESIDENCE AND …

APPLICATION AND AFFIDAVIT OF NONRESIDENCE AND MILITARY

SERVICE EXEMPTION FROM MOTOR VEHICLE AD VALOREM TAX

Incomplete documentation will not be processed 1. APPLICANT - This form is to be completed when the vehicle owner(s) meet the exemption requirements as the Servicemembers Civil Relief Act contained in 50 App. U.S.C.A. ? 571. Only the military individual or a lawful agent with power of attorney (POA) may execute this affidavit. Registration must be completed within 60 days of affidavit execution. This form, its contents and attachment shall be considered confidential and shall not be available for release to the public except in accordance with applicable law. Laramie County reserves the right, and the applicant, or their agent, by signature below agrees, that Laramie County or its agents may conduct such investigations as necessary and request any documentation as needed in their discretion to confirm the assertions made by applicant in the execution of this form. This process may result in delay in the granting of the exemption requested herein. Joint or co-ownership of a motor vehicle by a resident and non-resident may bar the granting of an exemption. False or misleading information provided herein or attempts to improperly procure exemption will result in referral to State or Federal law enforcement as well as the applicant's chain of command and criminal prosecution may result from same.

Military Owner's Name

Social Security Number

Wyoming Residence (Street Address, City and Zip)

County

Wyoming Military Installation Assigned to Under Orders

Duty Telephone Number ( )

Vehicle Identification Number (VIN)

Year Make Body

State Where Vehicle Purchased

Date of Purchase

State of Legal Residence

Date residence established

I, being first duly sworn, claim exemption from the fees imposed by W.S. 31-3-101 associated with the registration of a motor vehicle in the state of Wyoming based on eligibility for exemption under the Servicemembers Civil Relief Act. I am registering this vehicle in Wyoming and claiming exemption from the Specific Ownership Tax because the vehicle is located in Wyoming as a result of my military service. To support my claim, I further swear and affirm that: Intitials of Military Owner

? _____ I am not a legal resident of the State of Wyoming. ? _____ I am a member of the Armed Forces of the United States, serving under Title 10 orders in Wyoming. ? _____ I am a named owner on the vehicle for which the exemption is being claimed. ? _____This vehicle will not be used in any trade or business in the State of Wyoming. Should this vehicle be used as part of a business,

the vehicle will be subject to full payment of all taxes due. ? _____ I have not registered to vote in the State of Wyoming, applied for a veterans exemption for ad valorem tax as a veteran pursuant

to W.S. 39-13-105 or ? represented to any governmental or private entity that I am a resident of the State of Wyoming in order to procure any benefit ? Execution of this claim for exemption of specific ownership will require:

o Servicemember - Military ID is required to be presented with this form and copy of orders and leave and earning statement showing residency is required to be attached to this form.

o Servicemembers Spouse - Copy of orders and servicemembers leave and earning statement showing servicemembers residency and Power of Attorney is required to be attached to this form.

o Such other documentation as may be required by the Laramie County Treasurer to confirm eligibility I certify, under penalty of perjury, that the above statements are true and accurate. I execute this form with full knowledge of the penalties for making willfully false, fictitious or fraudulent statements as provided in W.S. 6-5-303 and other applicable law or regulation.

Printed name as it appears on identification of applicant:

Signature

Date

Office Use Only Wyoming DL

Military ID

Other:

Wyoming ID Orders

POA LES

I. CERTIFICATION OF COMMISIONED OFFICER OF MILITARY INSTALLATION

I certify that I am the ________________________________ of _________________________________ and that

Title

Unit

____________________________________________ is known to me to be a United States Armed Forces member assigned to

Military Owner

this military installation and under my command or I am an officer in the legal office of the command in which this member serves.

This service member is not a resident of the State of Wyoming and therefore eligible for exemption under the Servicemembers

Civil Relief Act. I have verified this information.

_______________________________________________________________________________________________________

Printed Name of Officer

Date

_______________________________________________________________________________________________________

Signature of Officer

Rank

_______________________________________________________________________________________________________

Military Installation

Duty Telephone Number

____________________________

II. VERIFICATION OF ABSENCE

(Must be completed when affidavit for exemption is executed by the lawful agent with

a Power of Attorney in military owner's absence. Section I of this form must also be

filled out)

I certify that I am the ___________________________________ of ___________________________________ and

Title

Unit

that the Armed Forces member referenced above as military owner in Section I of this form is regularly assigned to

my unit. He/She is temporarily absent from_________________________________________ on temporary duty until

______________________________________________________________________________________________

Location

Date

and cannot be present to personally register his/her motor vehicle and claim exemption from Wyoming ownership

taxes.

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