Form T 228 – Fill Out and Use This PDF

For m T- 228 ( Rev . 02 - 2005)

Affidav it of Fact for a Mot or cy cle or Mot or Scoot er

To obt ain a Geor gia cer t ificat e of t it le for t he m ot or cy cle or m ot or scoot er descr ibed below , cer t ain condit ions m ust apply . All sect ions of t his affidav it m ust be com plet ed. Ex cept for t he signat ures, t his affidav it m ust be t y ped, elect r onically com plet ed and pr int ed or pr int ed legibly by - hand in blue or black ink . Only t he vehicle ow ner ( s) or t he selling dealer can com plet e t his for m .

I m p or t a n t I n f or m a t ion : You ar e also r equir ed t o hav e a Geor gia law enfor cem ent officer com plet e a Cer t ificat ion of I nspect ion, For m T- 22B, for v er ificat ion t hat t he m ot orcy cle or

m ot or scoot er m eet s all Feder al m ot or vehicle safet y st andar ds by hav ing a NHTSA ( Nat ional Highw ay Traffic Safet y Adm inist r at ion) label affix ed. The com plet ed Cer t ificat ion of

I nspect ion, For m T- 22B, m ust be subm it t ed w it h t his com plet ed affidav it .

Pa r t 1( V e h icle V I N , M a k e a n d Ye a r M od e l)

Vehicle I dent ificat ion Num ber _________________________________________________

Vehicle Mak e________________________________ Vehicle Year Model______________

Pa r t 2

( V e h icle D e scr ip t ion – Ple a se An sw e r All Qu e st ion s) *

*All quest ions m ust be answ er ed “ Yes” in or der t o m ak e applicat ion for a Geor gia cer t ificat e of t it le

and/ or license plat e. A t it le/ license plat e w ill not be issued if it is det er m ined t hat t he v ehicle is not in t ot al com pliance.

Pa r t 3	( Sig n a t u r e & Ad d r e ss of Pe r son Com p le t in g Th is Af f id a v it )
________________________________		_____________________________________
Signat ur e		Dr iv er ’s License # & St at e of I ssue
________________________________________		______________________________________________
St r eet Addr ess		Pr int ed Nam e of Com pany ( if applicable)
________________________________________		______________________________________________
Cit y , St at e, & Zip		Posit ion w it h Com pany ( if applicable)
____________________________________		_____________________________________
Telephone Num ber I ncluding Ar ea Code		Com pany ’s Addr ess ( if applicable)

Pa r t 4( Ack n ow le d g e m e n t b y N ot a r y Pu b lic)

Sw or n t o and subscr ibed befor e m e t his _______ day of __________________ , _________

( Day )( Mont h)( Year )

________________________________	____________________________________
Not ar y ’s Signat ur e & Not ar y Seal or St am p	Not ar y ’s Pr int ed Nam e
________________________________	____________________________________
Not ar y ’s Dr iv er s License # & St at e of I ssue	Not ar y ’s St r eet Addr ess
________________________________	____________________________________
Dat e My Not ar y Com m ission Ex pir es	Not ar y ’s Cit y , St at e, & Zip

N ot e : Only t he v ehicle ow ner ( s)	or t he selling dealer can com plet e t his affidav it . I f	t he
m anufact ur er ’s cer t ificat e of or igin	does not indicat e t he m ot or cy cle or m ot or scoot er	w as
m anufact ured for highw ay use in t he Unit ed St at es, it m ay not be accept able.