Form Rv F1301201 – Fill Out and Use This PDF

Tennessee 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)