Gift Affidavit of Motor Vehicle 2016.04 - Rhode Island

1 STATE OF Rhode Island AND PROVIDENCE PLANTATIONS DEPARTMENT OF REVENUE DIVISION OF TAXATION excise TAX SECTION One Capitol Hill Providence, RI 02908-5800 SU 87 65 rev. 04/16 SALES AND USE TAX Affidavit OF gift OF Motor Vehicle (To be used for non-immediate family only) A notarized gift letter, in place of a Bill of Sale, must accompany this Affidavit . I _____, of _____ FULL NAME OF PERSON RECEIVING Vehicle ADDRESS: STREET & NUMBER APT or FLOOR # _____, _____, _____ hereby depose and say that on CITY/TOWN STATE ZIP CODE _____, 20_____, I did receive and accept as a gift or grant a DATE YEAR _____ _____ _____, Vehicle identification YEAR MAKE ( Chevrolet) MODEL ( Camaro) number _____, VIN from _____, of _____ FULL NAME OF PERSON GIFTING Vehicle ADDRESS.

2 STREET & NUMBER APT or FLOOR # _____, _____, _____. CITY/TOWN STATE ZIP CODE What is the relationship of the person who gifted you the Vehicle : _____ I swear that no monies, services, barter arrangements, or other articles or things of value or consideration in any form were paid or given in connection with or relating to the gift of this Vehicle . If subsequent information discloses that the statements contained herein are false, then all penalties imposed by law will be evoked. Signed under penalty of perjury on this _____ day of _____, 20_____.

3 NUMBER MONTH YEAR _____ GRANTEE S SIGNATURE (PERSON RECEIVING gift ) NOTARY PUBLIC _____ _____ NOTARY PUBLIC SIGNATURE NOTARY PUBLIC PRINTED NAME _____ _____ COMMISSION EXPIRATION DATE (MANDATORY) TODAY S DATE