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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 TAX D TRANSFEREE C 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: PRINT CLEAR