Form Mvu-21 - Affidavit In Support Of A Claim For Exemption From Sales Or Use Tax For A Motor Vehicle Transferred By Contest, Drawing Or Raffle

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Form MVU-21
Rev. 4/99
Affidavit in Support of a Claim for Exemption
Massachusetts
from Sales or Use Tax for a Motor Vehicle
Department of
Transferred by Contest, Drawing or Raffle
Revenue
Please read the instructions below before completing this form and provide the following information.
All entries must be printed or typed except for signatures.
This claim for exemption is based on a transfer of a motor vehicle without consideration as a result of winning a contest, drawing or raffle.
Warning: Willful misuse of this affidavit is punishable as a felony under Massachusetts General Laws, Chapter 62C, section 73 or Chapter 268,
section 1A.
Motor Vehicle Transferred:
Year
Make
Model
Vehicle identification number
Title number
Name of donor (dealer)
Address
City/Town
State
Zip
Name of sponsor
Address
City/Town
State
Zip
Name of contest/drawing/raffle winner
Address
City/Town
State
Zip
Sales/use tax has been paid by (name of sponsor or donor)
Declaration
I declare under the pains and penalties of perjury that I have reviewed this affidavit and the statements I have made in it and declare that they
are true.
Winner’s signature
Date
Sponsor’s signature
Date
Instructions
Under Massachusetts law, all purchasers of motor vehicles ac-
To be valid, all items on Form MVU-21 must be completed. Please
quired for use, storage or consumption in Massachusetts are re-
print or type all items except signatures. If you have any questions
quired to pay a sales or use tax unless a specific exemption is pro-
about the acceptance or use of this affidavit, please contact:
vided. However, any person to whom a motor vehicle title is trans-
Massachusetts Department of Revenue
ferred as a result of a contest, drawing or raffle may be exempt
Customer Service Bureau
from the sales or use tax. To qualify for this exemption, you must
PO Box 7010
meet all the requirements of the law and complete this affidavit.
Boston, MA 02204
(617) 887-MDOR
This form is approved by the Commissioner of Revenue and may be reproduced.

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