Please read the instructions below before completing this form and provide the following information.
All entries must be printed or typed except for signatures. This claim for exemption is based on a transfer of a motor vehicle as a gift. Motor Vehicle Transferred: Vehicle identification number Title number transferred the above-described vehicle to Both the donor and the donee declare: 1. Did either party make or receive payment in any form in connection with the transfer?2. Did either party make a promise of payment for the vehicle, or does either party expect payment in the future?
3. Did either party assume any debt in connection with the transfer? 4. At the time of the transfer, did the donor intend to make a gift of the vehicle to the donee? DeclarationI declare under the pains and penalties of perjury that I have reviewed this affidavit and the statements I have made in it and declare that they
Donor’s signature Donee’s signature Instructions The purchaser of a motor vehicle acquired for use, storage or Please note that your statements are to be made under the pains other consumption in the Commonwealth of Massachusetts is and penalties of perjury and that a statement which is made will- required to pay a sales or use tax unless an exemption is specifi- fully and is false as to a material matter may be punished as a cally provided for in the Massachusetts General Laws or the felony under Massachusetts General Laws, Chapter 62C, sec- Code of Massachusetts Regulations. tion 73, or Chapter 268, section 1A. Perjury is a serious crime and punishment can be severe. An exemption from the sales or use tax for a motor vehicle trans- ferred as a gift is provided for in the Massachusetts regulations If you have any questions about the acceptance or use of this and statutes. In order to be exempt from the sales and use tax, affidavit, please contact: you must meet the requirements of the law and complete the Massachusetts Department of Revenue affidavit above. You must fill in all blanks and print or type your Customer Service Bureau entries, except at the end of the affidavit where your signatures PO Box 7010 are required. Boston, MA 02204 (617) 887-MDOR This form is approved by the Commissioner of Revenue and may be reproduced.This website or its third-party tools use cookies, which are necessary to its functioning and required to achieve the purposes illustrated in the cookie policy. If you want to know more or withdraw your consent to all or some of the cookies, please refer to the cookie policy.
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