Form Rv-F1301201 - Affadavit Of Non-Dealer Transfers Of Motor Vehicles And Boats
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1Tennessee Department of Revenue
AFFADAVIT OF NON -DEALER TRANSFERS OF MOTOR VEHICLES AND BOATS
Lineal relative transfer (Persons qualified when related to transfer as: spouse, sibling, child, grandchild, great grandchild,
parent, grandparent, great grandparent, and spouse of lineal relative)
Gift transfer or low selling price to person other than lineal relative (Low selling price is considered to be 75% or less
of the fair market value by reference to the most recent issue of an authoritative automotive pricing manual, such as the
N.A.D.A. Official Used Car Guide, SE Edition)
Seller of Transferor
Purchaser of Transferee
(Please Print)
(Please Print)
Name: _________________________________________
Name: _________________________________________
Address: ________________________________________
Address: ________________________________________
City,State,Zip: ___________________________________
City,State,Zip: ___________________________________
Phone: _________________________________________
Phone: _________________________________________
FEIN or Drivers License No. ________________________
FEIN or Drivers License No. ________________________
Vehicle or Boat Information (To be completed by seller or transferor):
____________
____________________________________
_____________________________________________
Year
Make
(VIN or Serial No.)
Date of Sale: _____________________
Fair Market Value of the vehicle $ __________________________________
Is there a lien? Y/N ________________
If yes, what is the amount of the outstanding lien? ______________________
If yes, who is the lienholder? ______________________________________________________________________________
If applicable, please state the relationship between seller or Transferor and Purchaser or Transferee: _____________________
This box to be completed if gift or low selling price only
Considerations involved in the transfer: (Please check all that apply)
__________Money involved:
$_____________________________
__________Loan Assumption, loan pay-off, etc.:
$_____________________________
__________Services or labor performed:
Value:
$_____________________________
__________Other: (Explain) ______________________________________________________________________________
__________Trade-in: (Trade-in must be of like kind, such as motor vehicle, motorcycle, boat, etc. in order to get sales tax
credit for trade-in)
Trade-in value: $____________ Trade Description: ____________ _____________________ ________________________
Year
Make
(VIN or Serial No.)
Total Sales Price: $__________________________ (The sales price is the total amount of consideration paid by the purchaser
or transferee, including any paid to a third party, such as lienholder. If no consideration was given for the transfer, then the
amount of the sales price is $0.)
If the sales price is lower than the average value please indicate the reason for the low price: ___________________________
______________________________________________________________________________________________________
Under the penalties of perjury, I swear that the foregoing information is true and correct to the best of my knowledge,
information and belief, and this document correctly state the total amount of consideration for the transfer of this vehicle or
boat. I understand that failure to report proper consideration for the sale or transfer of the aforementioned vehicle or boat may
result in assessment of applicable sales tax, penalty and interest against the purchaser.
__________________________________________________ __________________________________________________
Seller or Transferor’s Signature(s)
Date
Purchaser or Transferee’s Signature(s)
Date
RV-F1301201 (Rev. 5-00)
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