Form Mv-13st - Affidavit Of Gift
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2MV-13ST (4-09)
Affidavit
of
Gift
Bureau of Motor Vehicles
1101 S. Front Street
Harrisburg, PA 17104
For Department Use Only
INSTRUCTIONS ON REVERSE SIDE OF FORM
Title Number: __________________________________________
VIN Number: __________________________________
Make of Vehicle:
Model: _____________________
Year: ________
____________________________________________
Transferor No. 1: ______________________________________
Transferee No. 1:________________________________
(please print)
(please print)
Transferor No.2: _______________________________________ Transferee No. 2: ______________________________
(please print)
(please print)
s the transferee related to the transferor?
Yes
No
K
K
I
Identify all the parties and relationship
(for example: father/son; mother/daughter; uncle/nephew; friend/friend):
______________________
WARNING:
FALSIFICATION OF THIS AFFIDAVIT COULD RESULT IN CRIMINAL PROSECUTION AND THE
REVOCATION OF YOUR DRIVING PRIVILEGES FOR A PERIOD OF ONE YEAR
The undersigned transferor(s) hereby declare(s) under penalty of perjury that I/we have received nothing of value,
either directly or indirectly, from the transferee(s) or any other individual or entity in consideration of the transfer of
the above-described vehicle, including but not limited to money, property, services or the forgiveness or waiver of any
debt, obligation or encumbrance and that all information provided herein is true and correct to the best of my/our
information and belief.
Transferor No. 1: _______________________________ ____________________
____________
______________
Transferor Signature (or Authorized Person for Corporation)
Date
PA DL/Photo ID # or Bus. ID#
Date of Birth
Address: _____________________________________________________________________________________________
Street
City
State
Zip Code
Transferor No. 2: _______________________________ ____________________
____________
______________
Transferor Signature (or Authorized Person for Corporation)
PA DL/Photo ID #
Date
Date of Birth
Address: _____________________________________________________________________________________________
Street
City
State
Zip Code
The undersigned transferee(s) hereby declare(s) under penalty of perjury that I/we have given nothing of value,
either directly or indirectly, to the transferor(s) or any other individual or entity in consideration for the transfer of the
above-described vehicle, including but not limited to money, property, service or the forgiveness or waiver of any debt,
obligation or encumbrance and that all information provided herein is true and correct to the best of my/our information
and belief.
Transferee No. 1: _______________________________ ____________________
____________
______________
Transferee Signature (or Authorized Person for Corporation)
Date
PA DL/Photo ID # or Bus. ID#
Date of Birth
Address: _____________________________________________________________________________________________
Street
City
State
Zip Code
Transferee No. 2: _______________________________ ____________________
____________
______________
Transferee Signature (or Authorized Person for Corporation)
Date
PA DL/Photo ID #
Date of Birth
Address: _____________________________________________________________________________________________
Street
City
State
Zip Code
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