Transcript
71A100 (8-06)
COPY DISTRIBUTION
AFFIDAVIT OF TOTAL CONSIDERATION GIVEN FOR A MOTOR VEHICLE
Commonwealth of Kentucky DEPARTMENT OF REVENUE
SELLER SECTION
WHITE—County Clerk CANARY—Dept. of Revenue PINK—Seller GOLDENROD—Buyer
BUYER SECTION Date of Purchase
____________________________________________________ ____________________________________________________ Name of Seller
Social Security No. or Federal ID No.
Social Security No. or Federal ID No.
Name of Buyer
____________________________________________________ ____________________________________________________ Street Address
Phone No.
Street Address
Phone No.
____________________________________________________ ____________________________________________________ City
County
State
ZIP Code
City
County
State
ZIP Code
VEHICLE IDENTIFICATION SECTION
VEHICLE TRADE-IN SECTION
____________________________________________________
$ ____________________________________________________
Vehicle Identification Number
Title Number
Trade-in Allowance
____________________________________________________
____________________________________________________
Year
Year
Make
Model
Body Style
Cylinders
Make
Model
Plate Number
KRS 138.450(9) defines “Total Consideration Given” as the amount given, valued in money, whether received in money or otherwise, at the time of purchase or at a later date, including consideration given for all equipment and accessories, standard and optional, as attested to in a notarized affidavit signed by both the buyer and the seller. NEW VEHICLES Total Consideration Given* (Total selling price with no deduction for trade-in.)
USED VEHICLES
$ __________________
Selling Price
$ __________________
Less Trade-in Allowance
$ __________________
Total Consideration Given*
$ __________________
Comments
*Total consideration given includes cash, the amount financed, and the value, in money, of other items (boats, trailers, guns, etc.) offered in trade for the vehicle being purchased, but does not include the value of any rebates, service contracts, extended warranties, finance charges, etc. In the case of new vehicles, total consideration includes the value assigned by the dealer for any vehicle traded in. In the case of used vehicles, total consideration does not include the value assigned by the seller for any motor vehicle traded in. Any person who willfully and fraudulently gives a false statement as to the total and actual consideration paid for a motor vehicle under Section 3 of this Act shall be guilty of a Class D felony and shall be fined not less than $2,000 per offense. I declare and affirm under penalty of law that the information given herein to the best of my knowledge and belief represents the “total consideration given” in exchange for the vehicle and “trade-in allowance” granted for any vehicle traded in. Seller’s Signature
Date
Attesting Official
Title
Buyer’s Signature
Attesting Official
Date
Title
Subscribed and sworn to before me this ______day of ______ 19 ____
Subscribed and sworn to before me this ______day of ______ 19 ____
My commission expires _________________________________________
My commission expires _________________________________________
