Arkansas Tax Credit for Replacement Vehicle Bill of SaleArkansas Tax Credit for Replacement Vehicle Bill of Sale
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Arkansas Department of Finance and Administration
Revenue Division
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Bill of Sale
(For a vehicle claimed as a tax credit towards the purchase of a replacement vehicle)
Purchaser(s) Name(s)

Phone Number

Address
City, State, Zip

Seller(s) Names

Phone Number

Address
City, State, Zip

Year, Make, Model of Vehicle Sold
Vehicle Identification Number (VIN)

Odometer Reading

Date Vehicle Sold

Sale Price

Purchaser’s Acknowledgement: I (we) hereby swear and affirm that the above information is true and correct. I
understand that any attempt to evade or defeat the payment of the proper amount of tax on the aforementioned
vehicle by making any false statement is a felony under Arkansas law punishable by fine, imprisonment, or both.

Signature of Purchaser(s)

Date

Seller’s Acknowledgement: I (we) hereby swear and affirm that the above information is true
and correct, and that said vehicle was owned and sold by me, and that I am entitl