- Form MV-80L - Eye Test Report for Medical Review Unit - New York
- Form MV-80 - Physician's Statement - New York
- Form DS-6 - Physician's Request for Driver Review - New York
- Form UT-11C - County Use Tax Exemption Certificate - New York
- Form MV-44NYR - Certification of Residence - New York
- Form DS-115 - Request for Driving Privileges - New York
Fillable Printable Form UT-11C - County Use Tax Exemption Certificate - New York
Fillable Printable Form UT-11C - County Use Tax Exemption Certificate - New York
Form UT-11C - County Use Tax Exemption Certificate - New York
New York State Department of Motor Vehicles
COUNTY VEHICLE USE
TAX EXEMPTION CERTIFICATE
As the registrant, I certify that the vehicle described below is not subject to a county use tax for the following reason
(check one):
o A. I am not a legal resident of ____________________________________ County. I reside in
_________________________________ County.
o B. The vehicle is owned by a non-profit religious, charitable or educational organization that is exempt
from the tax, as determined by the NYS Department of Taxation and Finance.
The tax exemption number is ___________________________.
o C. The vehicle is used only in connection with the operation of a farm by the owner or tenant of the farm.
I understand that this certification will be forwarded to the appropriate county for review, and that if I falsely state
that this vehicle qualifies for exemption, I may be subject to punishment under Section 210.45 of the Penal Law, and
that I may have to pay penalties and interest as provided by law.
UT-11C (6/11)
State Zip Code
Sign Name in Full
รง
Name of Registrant (Please Print)
Street City
Plate Number Year of Vehicle Make of Vehicle
County
Date
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