Clear Form
FORM
STATE OF HAWAII — DEPARTMENT OF TAXATION
G-27A
MOTOR VEHICLE USE TAX CERTIFICATION
(2004)
Affidavit in Support of a Claim for Exemption from
Use Tax for a Motor Vehicle Transferred as a Gift
(Attach to Form G-27)
(Type or Print Legibly All Information Reported on This Form)
Motor Vehicle Transferred:
Make Of Vehicle:
Model Year of Vehicle:
Vehicle Identification Number (VIN):
The undersigned parties hereby certify that the vehicle was a gift as described by the following statements:
(1) I,
, of
Transferor
Address
City
State
Zip Code
transferred the above-described vehicle to
, of
Transferee
Address
on
as a gift.
City
State
Zip Code
Date
Note: Attach a copy of the Transfer of Title document executed with the County Motor Vehicle Department.
(2) Both the transferor and the transferee declare:
•
The transferor and transferee did not make or receive payment in any form in connection with the transfer.
•
The transferor and transferee did not promise to pay for the vehicle or expect payment in the future.
•
The transferor and transferee did not assume any debt in connection with the transfer.
Declaration
The undersigned further certifies to the foregoing as the transferor or transferee or authorized agent or representative of the transferor or
transferee of the vehicle described above under section 231-36, HRS, which provides that misstatements relating to the use tax on returns,
statements, or other documents shall be a misdemeanor, punishable by a fine of up to $2,000 or imprisonment of not more than one year,
and/or probation.
Transferor’s Signature
Date
Transferee’s Signature
Date
Note: All required applicable documents must be attached for this exemption to be considered.
FORM G-27A