Purpose: Use this form to certify the purchase price of a motor vehicle 5 years old or less in order to obtain a title for that
vehicle. NOTE: Do not use this form for vehicles more than 5 years old, use a Vehicle Price Certification form
(SUT 1) or a bill of sale.
Instructions: Complete the form, have it notarized and submit it with other titling paperwork.
NOTARIZATION (must be completed by notary public)
MY COMMISSION EXPIRES (mm/dd/yyyy) REGISTRATION NUMBER
NOTARY PUBLIC NAME NOTARY PUBLIC SIGNATURE
State/Commonwealth of ______________________, city or county of _____________________________
subscribed and sworn to before me on this ____________ day of ________________________________
(MONTH) (YEAR)
by___________________________________________________ in the city or county and state aforesaid.
NOTARY PUBLIC SEAL
In accordance with all applicable statutes, administrative rules and regulations I certify that the purchase price of the above-described motor vehicle
was $ _____________________________, which included all accessories and/or attachments with no trade-in allowance or any other transaction.
I further certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and
that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and
I understand that knowingly making a false statement or representation on this form is a criminal violation.
CERTIFICATION
APPLICANT NAME (print) DATE (mm/dd/yyyy)
CO-SIGNER SIGNATURE
CO-SIGNER NAME (print) DATE (mm/dd/yyyy)
APPLICANT SIGNATURE
AFFIDAVIT OF VEHICLE PURCHASE PRICE
(VEHICLE MUST BE 5 YEARS OLD OR LESS)
SUT 1A (08/10/2017)
VEHICLE INFORMATION
SALE DATE (mm/dd/yyyy)VEHICLE IDENTIFICATION NUMBER (VIN) COLOR
YEAR (5 years old or less)
MAKE MODEL BODY TYPE
