50-285 (Rev. 9-03/1)
LESSEE'S AFFIDAVIT OF PRIMARILY NON INCOME PRODUCING VEHICLE USE
Appraisal district name
YEAR
For the owner of a vehicle leased for personal use, this affidavit must be completed by the person leasing the vehicle. This document must then be retained by the owner of the leased vehicle and made available to the appraisal district, on request, for copying or inspection.
Step 1: Provide data about the leased vehicle.
Your lease agreement or title should provide you with the information about your leased automobile required by boxes 1 through 10.
1. Vehicle Identification Number 2. Year
3. Make
4. Body style
5. Model
6. Empty weight*
7. Lease date
8. Owner name and address 10. Driver's License number or Personal Identification number:
9. Lessee name
Step 2: Provide information about your home address. Step 3: Provide information if your vehicle is not at home address. Step 4: Notary
If you do not have a street address, please provide your mailing address.
11. Lessee street or mailing address 12. City 13. State 14. ZIP code 15. County name
If the vehicle is usually located at an address other than the home address you provided in Step 2, or if the address provided in Step 2 is a post office box or rural route, provide the physical address at which the vehicle is primarily located.
16. Vehicle street address 17. City 18. State 19. Zip code 20. County name
Notarization by the person leasing the vehicle. I swear and affirm that I will not hold the vehicle for the production of income. The above described leased vehicle is used primarily for activities that do not produce income.** I affirm that each item stated above is true and correct and I understand that if at any time this affidavit becomes inaccurate, I must notify the person from whom I leased the vehicle.
Lessee signature
Subscribed and sworn before me this ____________day of ____________________________, 20____
_______________________________________________________
Notary Public, State of Texas
You are required to give us this information on this form, in order to perform tax related functions for this office. Section 11.43 of the Tax
Code authorizes this office to request this information to determine tax compliance. The chief appraiser is required to keep the information confidential and not open to public inspection, except to appraisal office employees who appraise property and as authorized by Section 11.48(b), Tax Code. * If the empty weight of the leased vehicle exceeds 9,000 pounds, the vehicle does not qualify for this exemption. ** Section 11.252, Tax Code, provides that a vehicle is used primarily for non-income producing activities when 50 percent or more of the total mileage for a 12-month period was for non-income producing purposes.
If you make a false statement on this form, you could be found guilty of a class A misdemeanor or state jail felony under Texas Penal Code Section 37.10.