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Form MV-16 (Rev.

07-2014)
PRINT CLEAR Web and MV Manual

Georgia Department of Revenue - Motor Vehicle Division


Affidavit to Certify Immediate Family Relationship
______________________________________________________________________________________
Purpose of this Affidavit: This affidavit provides evidence that the listed vehicle was transferred (whether gifted, purchased or
inherited) between persons who are immediate family members. (Spouse, Parent, Child, Sibling, Grandparent, Grandchild).
Please Note: Any person who falsifies any information in this affidavit shall be subject to a penalty not to exceed $2,500.00 as a
state penalty and not to exceed $2,500.00 as a local penalty as determined by the State Revenue Commissioner.

A VEHICLE INFORMATION

VIN: ____________________________________________________ Year: _____________ Make: _______________________________

B TRANSFEROR

By signing this affidavit I acknowledge my relationship with the Transferee as an immediate family member.

Transferor’s Printed Transferor’s


Name/Relationship: ______________________________________ Signature (If applicable): __________________________________

Sworn to and subscribed before me this ________ day of _______________________, ____________


Notary Public’s
Full Legal Name (Printed or Typed): _______________________________________________________ Notary Seal or Stamp
Notary Public’s
Physical Address: ______________________________________________________________________
Notary Public’s Notary Public’s
Telephone Number: _________________________ Email Address: _______________________________________________________

Notary Public’s Signature: _________________________________________ Commission Expiration Date: ______________________

C TRANSFEREE

By signing this affidavit I acknowledge my relationship with the Transferor as an immediate family member.

Transferee’s Printed Transferee’s


Name/Relationship: ______________________________________ Signature: ______________________________________________

Sworn to and subscribed before me this ________ day of _______________________, ____________


Notary Public’s
Full Legal Name (Printed or Typed): _______________________________________________________ Notary Seal or Stamp
Notary Public’s
Physical Address: ______________________________________________________________________
Notary Public’s Notary Public’s
Telephone Number: _________________________ Email Address: _______________________________________________________

Notary Public’s Signature: _________________________________________ Commission Expiration Date: ______________________

D AD VALOREM TAX

I understand that the above referenced vehicle is currently under the Ad Valorem Tax System and I choose to remain in the Ad
Valorem Tax System. (Check only if applicable)
I will pay Title Ad Valorem Tax (TAVT) for the above vehicle.

Have a question? Scan the QR code above or visit our website at http://motor.etax.dor.ga.gov for more information.

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