Annual Purchaser’s Certification of Export-Only Sale

Period January to December

Instructions This form may only be used with automated export-only sales reports for salvage or nonrepairable motor vehicles.

In accordance with Texas Transportation Code, §501.099, you may only purchase a salvage or nonrepairable motor vehicle from a licensed dealer or a governmental entity for export if you are not a resident of the United States. The seller must obtain a legible copy of your government issued photo identification (ID) issued by a jurisdiction where you reside.

Please complete all fields of this form unless otherwise noted. Record the type of photo ID (i.e. passport, driver license, ID card), the jurisdiction that issued the photo ID, and the photo ID number.

Seller Information Dealer or Government Agency Name Dealer License Number (if applicable)

Address City State Zip

Purchaser Information First Name (or Entity Name) Middle Name Last Name Suffix (if any)

Type of Government Issued Photo ID Jurisdiction that Issued the Photo ID Photo ID Number

Address City Country Postal Code

Purchaser Certification - State law makes falsifying information a third degree felony I, the purchaser listed above, certify in accordance with Texas Transportation Code, §501.099, that I will remove the motor vehicle(s) described above from the United States, not return the motor vehicle(s) to any state of the United States as a motor vehicle titled or registered under its manufacturer’s vehicle identification number, and not operate or permit the operation of the motor vehicle(s) on a public highway.

Signature of Purchaser Printed Name (Same as Signature) Date

VTR-901-A Rev 05/20 Form available online at www.TxDMV.gov Page 1 of 1