Certificate Of Exemption From Registration Excise Tax On Aircraft Owned By An Indiana Resident And Based Out Of State {AE-1}

State Form 46815 (R6 / 10-16) AE-1 Form Certificate of Exemption from Registration/Excise Tax on Aircraft Owned by an Indiana Resident and Based Out of State Initially due within 31 days of purchase date. Each year thereafter, due on or before December 31. Indiana Department of Revenue Section A: Owner Information 1. Owner Name 4. Street Address 2. Telephone Number 3. Email Address 5. City, State and ZIP Code Section B: Aircraft Information 6. FAA N Number 9. Serial Number 12. Base Airport Name 7. Make 10. Year of Manufacture 13. Base Location Street Address 8. Model 11. Purchase Date 14. Base Location City, State and ZIP Code Section C: Documentation for Exemption 15. Indicate the type of supporting documentation included: Hangar Lease/Rental Agreement Hangar Lease/Rental Receipts Current Aircraft Registration Other: _____________________________ I hereby certify, under penalty of perjury, that this aircraft is exempt from Indiana aircraft registration requirements and excise tax because this aircraft is based out of state. _____________________________ Printed Name of Owner _______________________________ Signature of Owner ______________________ Date Mailing/Contact Information: Indiana Department of Revenue Special Tax Division P.O. Box 644 Indianapolis, IN 46206-0644 (317) 615-2544 aircrafttax@dor.in.gov American LegalNet, Inc. www.FormsWorkFlow.com