Clean Alternative Fuel Passenger Vehicle Leases and Sales — Form & Instructions

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REV 41 01021 (9/17/19) Form Clean alternative fuel passenger vehicle leases and sales addendum Complete this form to report sales and leases of clean alternative fuel vehicles. Both new and used vehicles qualify. If you sold or leased more than one vehicle, make copies and complete the form for each vehicle sold or leased. Business name ________________________________________________________________________ Account ID ____________________________________________ Reporting period _____________________ Vehicle information Complete the following information about the vehicle: 1. o Lease o Sale 2. o New o Used 3. Vehicle year _________________________ 4. Vehicle make ________________________ 5. Vehicle model ________________________ 6. Sale date/lease start date _______________ 7. Sales price before trade-in or fair market value at start of lease ______________ 8. Trade-in amount ______________________ 9. Deduction amount ____________________ For new leased vehicles, the deduction amount is equal to the cap reduction payment in addition to the first lease payment. For leased vehicles (do not complete if outright sale) 1. Term of lease in months ___________________ 2. First lease payment plus cap reduction _________________ 3. Monthly lease payment amount _____________

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REV 41 0121 (9/17/19) To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705. Teletype (TTY) users may use the Wa Relay Service by calling 711. What will we use this information for? The information on this form will be used by the Department of Revenue to create a report to the Legislature on the effectiveness of exemption as required by law (E2SHB 2042). Exemption amounts New vehicles with a sales price or fair market value of $45,000 or less Vehicle sales price minus trade-in value, or $25,000, whichever is less Aug. 1, 2019 - July 31, 2021 Vehicle sales price minus trade-in value, or $20,000, whichever is less Aug. 1, 2021 - July 31, 2023 Vehicle sales price minus trade-in value, or $15,000, whichever is less Aug. 1, 2023 - July 31, 2025 Used vehicles with a sales price or fair market value of $30,000 or less Vehicle sales price minus trade-in value, or $16,000, whichever is less Aug. 1, 2019 - July 31, 2025

Need help? If you need help completing this addendum, call 360-705-6705.