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Pennsylvania Vehicle Bill of Sale


Pennsylvania Vehicle Bill of Sale
Pennsylvania Vehicle Bill of Sale
SIGNATURE OF PERSON ADMINISTERING OATH
MV-3 (8-08)
Commonwealth of Pennsylvania
PA Department of Transportation
Bureau of Motor Vehicles
Harrisburg, PA 17104-2516
MOTOR VEHICLE VERIFICATION
OF FAIR MARKET VALUE BY
THE ISSUING AGENT
This form is used in conjunction with Forms MV-1, MV-4ST,
MV-217A and an on-line processing Applicant Summary Statement.
FOR DEPARTMENT USE ONLY
A VEHICLE DESCRIPTION
B AGENT VERIFICATION OF FAIR MARKET VALUE - Check (
) the appropriate block:
C PURCHASER INFORMATION
D PURCHASER/SELLER EXPLANATION
E SEAL AND SIGNATURE OF SELLER - NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF-STATE
Model Year
Vehicle Identification Number (VIN)
Signature of Authorized Agent
Last Name (or Full Business Name)
First Name Middle Name
Agent Number
Date
Odometer Reading
Make of Vehicle Model
Body Type
PURCHASE
PRICE
O
,
(No Tenths)
I certify that the average Fair Market Value for the vehicle described above is $
as verified by the current edition of a PennDOT approved publication.
Name of Publication: ________________________________
This vehicle or the fair market value for this vehicle was not listed in a current edition of a PennDOT
approved publication in my possession.
U
U
TYPE OR PRINT ALL INFORMATION AS REQUESTED
Explain in detail why the purchase price listed on Form MV-1, MV-4ST, MV-217 or Applicant Summary Statement is less than 80% of the average Fair Market Value, or if the
vehicle is over 15 years old and the purchase price is less than $500, explain how the purchase price was determined, or if the vehicle is not listed in a PennDOT approved
publication, explain how the purchase price as listed in Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An
additional audit of this vehicle sale by the Dep
artment of Revenue may occur. Please retain copies of this form, your cancelled check or original cash receipt, and
your receipt from the seller of this vehicle, along with either your copy of the Application for Certificate of Title (MV-1), the Vehicle Sales and Use Tax
Return/Application for Registration (MV-4ST) or the Application by Financial Institutions for Certificate of Title After Default by Owner (MV-217A).
If you fail to
reply to the Department of Revenue, you will be assessed for the estimated amount of tax due.
I/We state that I/we have read and signed this form after its completion, and I/we
swear or affirm that the statements made herein are true and correct, and that any
statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include punishment of a
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
S
T
A
M
P
SUBSCRIBED AND SWORN
TO BEFORE ME:
MONTH DAY YEAR
W
Signature of Seller
Signature of Co-Seller
Telephone Number
( )
DO NOT NOTARIZE UNLESS
SIGNED BY THE SELLER IN
PRESENCE OF NOTARY
F SEAL AND SIGNATURE OF PURCHASER
Messenger No.
THIS FORM MAY BE PHOTOCOPIED
SIGNATURE OF PERSON ADMINISTERING OATH
I/We state that I/we have read and signed this form after its completion, and I/we
swear or affirm that the statements made herein are true and correct, and that any
statement made on or pursuant to this form is subject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false swearing), which shall include punishment of a
fine not exceeding $5,000, or to a term or imprisonment of not more than two years,
or both.
SUBSCRIBED AND SWORN
TO BEFORE ME:
MONTH DAY YEAR
W
DO NOT NOTARIZE UNLESS
SIGNED BY THE PURCHASER IN
PRESENCE OF NOTARY
S
T
A
M
P
Signature of Purchaser
Signature of Co-Purchaser
Telephone Number
( )
PA DL/Photo ID#
or Bus. ID #
Date of Birth
Co-Purchaser Last Name
First Name Middle Name
PA DL/Photo ID#
Date of Birth
Pennsylvania Vehicle Bill of Sale
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