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MOTOR CARRIER APPLICATION FOR GOVERNMENTAL SERVICES TAX EXEMPTION

(Nevada Tribal Members Residing on Tribal Lands)

Instructions:

 This exemption must be applied for annually.

 A separate exemption application is required for each vehicle. The Exemption

application must be presented at the time of registration or renewal.

 The Tribal Chairman of the applicant’s Nevada Indian Tribe must certify that

the applicant meets the criteria for Governmental Services Tax exemption.

Please Print or Type

Account Number _______________Vehicle Year _________________ Make ______________

Model_______________________ License Plate Number_____________________________

Vehicle Identification Number:

Full Legal Name Last First M.I.

Physical Address Street City State Zip

Applicant’s Signature Date

I hereby certify that the above applicant is a member of the Nevada Indian Tribe residing on tribal

land and is entitled to a Governmental Services Tax exemption.

______________________________________________ __________________________

Tribal Chairman’s Name (Print) Tribal Agency

______________________________________________ __________________________

Tribal Chairman’s Signature Date

RD-154 (3-2005)

MOTOR CARRIER DIVISION

555 WRIGHT WA

CARSON CITY, NV 89711-0600

(775) 684-4711

Fax (775) 684-4619

www.dmvnv.com

For Department Use Only

Exemption Amount $ ___________________ Technicians Initials _______________

Date Processed _____________

MC024 (5-2005)

MOTOR CARRIER APPLICATION FOR GOVERNMENTAL SERVICES TAX EXEMPTION (Nevada Tribal Members Residing on Tribal Lands) Instructions:  This exempti

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