Free 01-917 Statement of Occasional Sale - Texas

01-917
(Rev.3-06/2)


STATEMENT OF OCCASIONAL SALE
Entity name (Corporation, partnership or sole proprietorship)

Mailing address

City

State

ZIP code

Daytime phone (Area code and number)

Provide a brief description of your business activities

I have read the State of Texas, Comptroller of Public Accounts, Limited Sales and Use Tax Rule 3.316 regarding Occasional Sales (34 Texas Administrative Code §3.316), and I hereby acknowledge that the following sale I made qualifies as an occasional sale:

Description of item sold (include year, model, serial numbers, etc.):
______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Date item sold

Sales price of item

Item sold to: (Name)

Address

Check the box below that applies to you: This was a transfer without change in ownership. My percentage of ownership prior to transfer was _______ %; my percentage of ownership after transfer was ________ %. I certify that I do not hold a sales tax permit in Texas or any other state and I have not made a sale of more than one other taxable item within the previous twelve months. I certify that I sold the entire operating assets of (1) a whole business or (2) a separate division, branch, or identifiable segment of a business with attributable income and expenses that can be separately established from the books of account or records of the business.

I understand that if any information provided here is later found to be incorrect, I may be held liable for collection of sales or use tax on the above item.
Print name Title

Signature

Date

You have certain rights under Chapters 552 and 559, Government Code, to review, request, and correct information we have on file about you.
For more information contact the Texas State Comptroller's office.