Service Nova Scotia
Program and Registry Managem ent
Sworn Statement for a Family Gift of a Used Motor Vehicle in the
Province of Nova Scotia
IN THE MATTER OF
the Revenue Act,
(Name of Recipient)
in the County of
, Province of Nova Scotia, and
(Name of Donor)
in the County of
, Province of __________________.
MAKE OATH AND SAY:
1. W e have personal knowledge of the matters hereinafter deposed to.
2. The Recipient is now the owner of the Used Motor Vehicle, named in the attached Application for Transfer.
3. The Used Motor Vehicle, owned by the said Recipient is a
bearing Vehicle Identification Number
4. The Donor is the
of the Recipient.
(Insert as appropriate: father, mother, step-father, step mother, step child, brother, sister, spouse, grandfather, grandmother, son, daughter, son-in law,
daughter-in-law, father-in-law, mother-in-law, grandson, granddaughter or; common law partners and same sex partners co-habitating for at least one
year or partners registered under the Vital Statistics Act as “domestic partners” )
5. If the vehicle was registered in the donor’s name in another province or territory when it was gifted, the vehicle was not permanently removed from
that province or territory within 30 days of the donor’s purchase of the vehicle.
6. The Used Motor Vehicle was acquired by the said
(Nam e of Owner/Recipient)
as a gift, for no monetary consideration or assumption of payment and has not been transferred
on a tax-exempt basis within the twelve month period preceding the acquisition.
SEVERALLY SWORN before me
(Signature of Recipient)
(Signature of Donor)
A Barrister, Commissioner, Notary or
Witnessed before Registry of Motor Vehicles Staff Person
WARNING: It is a serious offence to knowingly make a false statement herein.
This form must be printed and presented in person (along with other required documentation) at the
Registry of Motor Vehicle office when transferring the registration of the motor vehicle from the donor
to the recipient.