Form Mv-3 - Motor Vehicle Verification Of Fair Market Value By The Issuing Agent

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MV-3 (8-08)
MOTOR VEHICLE VERIFICATION
OF FAIR MARKET VALUE BY
Commonwealth of Pennsylvania
PA Department of Transportation
THE ISSUING AGENT
Bureau of Motor Vehicles
Harrisburg, PA 17104-2516
This form is used in conjunction with Forms MV-1, MV-4ST,
MV-217A and an on-line processing Applicant Summary Statement.
FOR DEPARTMENT USE ONLY
TYPE OR PRINT ALL INFORMATION AS REQUESTED
A VEHICLE DESCRIPTION
Model Year
Make of Vehicle
Model
Body Type
PURCHASE
PRICE
(No Tenths)
Vehicle Identification Number (VIN)
Odometer Reading
,
B AGENT VERIFICATION OF FAIR MARKET VALUE - Check (
) the appropriate block:
I certify that the average Fair Market Value for the vehicle described above is $
as verified by the current edition of a PennDOT approved publication.
Name of Publication: ________________________________
This vehicle or the fair market value for this vehicle was not listed in a current edition of a PennDOT
approved publication in my possession.
Signature of Authorized Agent
Agent Number
Date
C PURCHASER INFORMATION
PA DL/Photo ID#
Last Name (or Full Business Name)
First Name
Middle Name
Date of Birth
or Bus. ID #
Date of Birth
PA DL/Photo ID#
Co-Purchaser Last Name
First Name
Middle Name
D PURCHASER/SELLER EXPLANATION
Explain in detail why the purchase price listed on Form MV-1, MV-4ST, MV-217 or Applicant Summary Statement is less than 80% of the average Fair Market Value, or if the
vehicle is over 15 years old and the purchase price is less than $500, explain how the purchase price was determined, or if the vehicle is not listed in a PennDOT approved
publication, explain how the purchase price as listed in Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An
additional audit of this vehicle sale by the Department of Revenue may occur. Please retain copies of this form, your cancelled check or original cash receipt, and
your receipt from the seller of this vehicle, along with either your copy of the Application for Certificate of Title (MV-1), the Vehicle Sales and Use Tax
If you fail to
Return/Application for Registration (MV-4ST) or the Application by Financial Institutions for Certificate of Title After Default by Owner (MV-217A).
reply to the Department of Revenue, you will be assessed for the estimated amount of tax due.
E
SEAL AND SIGNATURE OF SELLER - NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF-STATE
I/We state that I/we have read and signed this form after its completion, and I/we
SUBSCRIBED AND SWORN
swear or affirm that the statements made herein are true and correct, and that any
TO BEFORE ME:
MONTH
DAY
YEAR
statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include punishment of a
SIGNATURE OF PERSON ADMINISTERING OATH
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
S
Signature of Seller
T
DO NOT NOTARIZE UNLESS
SIGNED BY THE SELLER IN
A
Signature of Co-Seller
PRESENCE OF NOTARY
M
Telephone Number
P
(
)
F SEAL AND SIGNATURE OF PURCHASER
I/We state that I/we have read and signed this form after its completion, and I/we
SUBSCRIBED AND SWORN
swear or affirm that the statements made herein are true and correct, and that any
TO BEFORE ME:
MONTH
DAY
YEAR
statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include punishment of a
SIGNATURE OF PERSON ADMINISTERING OATH
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
S
Signature of Purchaser
T
DO NOT NOTARIZE UNLESS
A
SIGNED BY THE PURCHASER IN
Signature of Co-Purchaser
PRESENCE OF NOTARY
M
Telephone Number
P
(
)
THIS FORM MAY BE PHOTOCOPIED
Messenger No.

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