novascotia.ca/nsst Page 1 of 1 SNS-IS-NSST-GIFT-V.15.11.19
Sworn Statement for a Family Gift
of a Used Motor Vehicle
in the Province of Nova Scotia
TO WIT:
IN THE MATTER OF the Revenue Act,
We, of
(Name of Recipient) (Address)
in the County of , Province of Nova Scotia, and
(County Name)
of
(Name of Donor) (Address)
in the County of ________
, Province of .
(County Name)
MAKE OATH AND SAY:
1.
We have personal knowledge of the matters hereinafter deposed to.
2.
The Recipient is now the owner of the Used Motor Vehicle, named in the attached Application for Transfer.
3.
The Used Motor Vehicle, owned by the said Recipient is a
(Year) (Make) (Model)
bearing Vehicle Identification Number .
4.
The Donor is the of the Recipient.
(Insert as appropriate: father, mother, step-father, step mother, step child, brother, sister, spouse, grandfather, grandmother, son, daughter, son-in law,
daughter-in-law, father-in-law, mother-in-law, grandson, granddaughter; common law partners co-habitating for at least one year or partners registered
under the Vital Statistics Act as “domestic partners”; OR former common-law partners/domestic partners, provided the transfer is agreed to by the Donor
and the Recipient as part of the dissolution of their common law relationship or domestic partnership and there is no written separation agreement).
5.
If the vehicle was registered in the Donor’s name in another province or territory when it was gifted, the vehicle was not permanently removed from
that province or territory within 30 days of the Donor’s purchase of the vehicle.
6.
The Used Motor Vehicle was acquired by the said on
(Name of Owner/Recipient) (Date)
from as a gift, for no monetary consideration or assumption of payment and has not been transferred
on
a tax-exempt basis within the twelve month period preceding the acquisition.
SEVERALLY SWORN before me
at )
(Office) ) (Signature of Recipient)
)
in )
(County Name) )
)
this day of 20 )
) (Signature of Donor)
)
)
A Barrister, Commissioner, Notary or
Witnessed before Registry of Motor Vehicles Staff Person
WARNING: It is a serious offence to knowingly make a false statement herein.
Note: This form must be printed and presented in person (along with other required documentation) at the
Registry of Motor Vehicle office when transferring the registration of the motor vehicle from the donor
to the recipient.
