Date of Issuance: [Date]

Dealer/Company Name: [Dealer Name or Company Name]
Dealer/Company Address: [Street Address, City, State, Postal Code]
Dealer/Company Contact Information:

• Phone Number: [Phone Number]
• Email Address: [Email Address]
• Tax Identification Number (TIN): [TIN Number]
• Sales Tax Registration Number: [Sales Tax Reg. Number]

BUYER INFORMATION

Buyer's Name: [Full Name or Company Name]
Buyer's Address: [Street Address, City, State, Postal Code]
Buyer's Contact Information:

• Phone Number: [Phone Number]
• Email Address: [Email Address]

VESSEL INFORMATION

Vessel Name: [Vessel Name]
Vessel Type: [Type of Vessel (e.g., Yacht, Cargo Ship, Fishing Vessel)]
Hull Number (or VIN if applicable): [Hull Number or Identification Number]
IMO Number (if applicable): [IMO Number]
Year of Manufacture: [Year]
Vessel Registration Number (if applicable): [Registration Number]
Purchase Price of Vessel: [Purchase Price]
Effective Date of Transaction: [Transaction Date]

SALES TAX DETAILS

• Sales Tax Rate: [Sales Tax Rate Percentage]
• Sales Tax Amount: [Sales Tax Amount]
• Total Amount Due (Including Sales Tax): [Total Amount Due, including Sales Tax]

SALES TAX BREAKDOWN

SALES TAX PAYMENT DETAILS

• Sales Tax Payment Due Date: [Due Date for Tax Payment]
• Method of Payment: [Method of Payment (e.g., Wire Transfer, Check)]
• Payment Instructions:
  • Bank Name: [Bank Name]
  • Account Name: [Account Name]
  • Account Number: [Bank Account Number]
  • Routing Number: [Routing Number]
  • SWIFT/BIC Code (if applicable): [SWIFT Code]
  • Reference Information: [Transaction Reference or Vessel Name]
• Sales Tax Payment Confirmation: [Sales Tax Payment Confirmation Details]

NOTES AND DISCLOSURES

1. Sales Tax Applicability: This sales tax statement applies to the sale of the above-referenced vessel and reflects the applicable state/local sales tax rates as of the transaction date.

2. Tax Exemption: [Any applicable tax exemptions, such as if the buyer is tax-exempt, or if the transaction qualifies for any special tax rates, should be listed here].

3. Tax Reporting: The dealer is responsible for reporting the collected sales tax to the appropriate state/local tax authorities and remitting it accordingly.

4. Buyer’s Responsibility: It is the buyer’s responsibility to ensure that the sales tax payment is made on time and in full.

DEALER CERTIFICATION

By signing below, the dealer certifies that the sales tax amount stated above has been calculated in accordance with the applicable laws and regulations. The dealer also affirms that the information provided in this statement is accurate and reflects the sales tax due on the sale of the vessel described.

Dealer's Authorized Signature: ________________________
Name of Authorized Signatory: [Full Name]
Title: [Title of Signatory]
Date: [Date of Signature]

BUYER ACKNOWLEDGEMENT

By signing below, the buyer acknowledges receipt of this Dealer Sales Tax Statement and agrees to the amount of sales tax indicated herein. The buyer also affirms that the sales tax payment will be made according to the instructions provided.

Buyer's Signature: ________________________
Name of Buyer: [Full Name]
Title (if applicable): [Title, if applicable]
Date: [Date of Signature]

CONTACT INFORMATION FOR SALES TAX INQUIRIES

For questions regarding this Sales Tax Statement, please contact:

Dealer Name: [Dealer Name]
Phone Number: [Phone Number]
Email Address: [Email Address]
Sales Tax Department Contact: [Contact Name or Department]
Tax Authority: [Applicable Tax Authority, if necessary]