Transcription of STATE OF CONNECTICUT
1 STATE OF CONNECTICUT Motor Vehicle and vessel gift declaration I, _____ the undersigned (donor), residing at Donor s name (print) _____, STATE that: Street address City STATE on or about _____, I transferred ownership and title of a Date Motor Vehicle or vessel _____ Motor Vehicle or Hull Identification Number (VIN or HIN) _____ _____ _____ Year Make Model to _____ (donee), Donee s name (print) receiving no compensation in return, in either cash, property or personal services; There has been neither a promise to pay for said vehicle or vessel nor any expectation of any future compensation in either cash, property or personal services from the donee; and The donee has not assumed payment of any chattel mortgage or conditional bill of sale on the vehicle or vessel described above. I declare under penalties of false statement that I have examined this information and to the best of my knowledge and belief it is true, complete, and correct.
2 (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed two thousand dollars, or both.) Donor: Print donor name Donor signature Date Donee: Print donee name Donee signature Date AU-463 (Rev. 12/2012)
