Georgia Department of Revenue - Motor Vehicle Division
Affidavit to Certify Immediate Family Relationship
Form MV-16 (Rev. 07-2014)
Web and MV Manual
______________________________________________________________________________________
VEHICLE INFORMATION
VIN: ____________________________________________________ Year: _____________ Make: _______________________________
TRANSFEROR
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.
Transferor’s
Signature (If applicable): __________________________________
A
B
Sworn to and subscribed before me this ________ day of _______________________, ____________
Notary Public’s
Full Legal Name (Printed or Typed): _______________________________________________________
Notary Public’s
Physical Address: ______________________________________________________________________
Notary Public’s
Telephone Number: _________________________
Notary Public’s Signature: _________________________________________ Commission Expiration Date: ______________________
Notary Seal or Stamp
Have a question? Scan the QR code above or visit our website at http://motor.etax.dor.ga.gov for more information.
Notary Public’s
Email Address: _______________________________________________________
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.
AD VALOREM TAXD
TRANSFEREEC
By signing this affidavit I acknowledge my relationship with the Transferee as an immediate family member.
Sworn to and subscribed before me this ________ day of _______________________, ____________
Notary Public’s
Full Legal Name (Printed or Typed): _______________________________________________________
Notary Public’s
Physical Address: ______________________________________________________________________
Notary Public’s
Telephone Number: _________________________
Notary Public’s Signature: _________________________________________ Commission Expiration Date: ______________________
Notary Public’s
Email Address: _______________________________________________________
Notary Seal or Stamp
Transferor’s Printed
Name/Relationship: ______________________________________
Transferee’s
Signature: ______________________________________________
By signing this affidavit I acknowledge my relationship with the Transferor as an immediate family member.
Transferee’s Printed
Name/Relationship: ______________________________________
