State of Rhode Island Division of Taxation 
      Form C-REF-SU 
      Claim for Refund - Sales and Use Tax 

 Purchaser name/transferee                                              Federal employer identification number/social security number

 Address                                                                Date of purchase/transfer

 Address 2

 City, town or post office                State ZIP code                E-mail address

 CLAIM FOR REFUND - SALES AND USE TAX ON CASUAL PURCHASE OF MOTOR VEHICLE 
                                                                  
AUTHORITY TO ASSESS ON BOOK VALUE: RI Gen. Law 44-18-20 provides that a 7% excise tax be imposed on the storage, use or 
consumption in this State of a new or used motor vehicle based on the sale price.  However, when the purchase of a motor vehicle is 
from a person or entity other than a licensed motor vehicle dealer, the tax imposed shall be on the retail dollar value at the time of pur-
chase, or the sales price, whichever is higher.  The Tax Administrator shall designate and use as his guide the retail value as shown in 
the current issue of a nationally recognized used vehicle guide. 
 
APPEAL PROCEDURE:  Within thirty (30) days after payment of the tax, you may appeal the retail dollar value of assessment by com-
pleting this form and mailing it to: Rhode Island Division of Taxation, Excise Tax Section, One Capitol Hill, Providence, RI 02908. 
Indicate why refund should be allowed by checking one (1) of the following boxes AND providing the documentation listed: 
 
      APPRAISAL - The attached affidavit of vehicle examination and appraisal to be completed by a licensed RI motor vehicle dealer 
 
      BILLS/ESTIMATES - Documentation (i.e.) itemized written estimates, paid repair bills) from auto body shops, repair garages,      
      etc. to support your claim. 
 
      HIGH MILEAGE - Notarized statement of mileage 
 
      LEASED VEHICLE - Copy of your lease contract showing buy-out price or residual value at termination of lease if purchased 
      from a leasing company (only if purchaser is the original lessee).
Name of seller/transferor: 
 
Address:                                             City/town, State, ZIP code:
                                                                        Odometer reading 
Year:         Make:                           Model:                    at time of purchase:
Retail dollar value assessed at Registry:                               Purchase price: 
 
Value claimed per documentation:                                        Redetermined tax: 
(Cannot be less than purchase price.)                                   (Tax rate x value claimed) 
 
Tax paid ___________________ Amount of tax to be refunded (Tax paid less redetermined tax) 
          Signature and federal employer identification number or social security number must be entered above.   
                           IMPORTANT:  The following documentation must be submitted with this claim: 
1.  Copy of your yellow motor vehicle registration or, if not registered, a copy of stamped use tax payment receipt. 
2.  Copy of your Bill of Sale. 
3.  The documentation listed next to the appeal box checked above. 
                           DOCUMENTATION IS REQUIRED FOR APPROVAL
 Under penalties of perjury, I declare I have examined this claim and statements, and to the best of my knowledge and belief, it is true, accurate and complete.
 Purchaser signature                      Print name                                 Date        Telephone number

           RI Division of Taxation - Excise Tax Section - One Capitol Hill - Providence - RI - 02908

       State of Rhode Island Division of Taxation 
       Form C-REF-SU 
       Affidavit of Vehicle Examination and Appraisal

 Dealer name                                                     Claimant (vehicle owner) name

 Address                                                         Claimant address

 Address 2                                                       Claimant address 2

 City, town or post office                  State ZIP code       City, town or post office                      State ZIP code

                           AFFIDAVIT OF VEHICLE EXAMINATION AND APPRAISAL 
       TO BE COMPLETED BY A LICENSED RHODE ISLAND MOTOR VEHICLE DEALER 
             Mailing address: RI Division of Taxation, Excise Tax Section, One Capitol Hill, Providence, RI 02908 

Vehicle Information: 
                                                           Year: 
                                                              
                                                           Make: 
                                                              
                                                  Model: 
                                                              
                           Vehicle Identification Number: 
                                                              
 National Automotive Dealer Association (NADA) Retail 
                           Book Value - New England Edition: 
                                                              
             Odometer Reading at Time of Appraisal:

                                                  APPRAISAL
                                                  GOOD - FAIR - POOR
 Interior:                                                    Paint:
 Exterior (body):                                             Other:
 Engine:                                                      Comments:
 Tires:
                    FINAL APPRAISED RETAIL VALUE $ 
I hereby certify that I am an authorized motor vehicle representative of the above-named business and that 
such business is duly licensed as a MOTOR VEHICLE DEALER IN THE STATE OF RHODE ISLAND holding 
 
DEALER LICENSE NUMBER    ___________________________ and  
 
SALES TAX PERMIT NUMBER ___________________________.

                           ALL APPRAISALS ARE SUBJECT TO REVIEW

           Under penalties of perjury, I declare I have examined subject vehicle and all statements or information provided herein,  
                           and to the best of my knowledge and belief, they are all true, accurate and complete.
 Authorized dealer representative signature       Print name                     Title                                Date

             RI Division of Taxation - Excise Tax Section - One Capitol Hill - Providence - RI - 02908