Government of Ontario: Ministry of Finance

Retail Sales Tax
33 King Street West
PO Box 623
Oshawa ON L1H 8H7

Sworn Statement for the Transfer of a Used Vehicle in the Province of Ontario

TO WIT: Under the Retail Sales Tax Act, R.S.O. 1990, c.R.31 (as amended), clause 4.2(4) (a)(b)(c)(e), 4.2(8), 8(2), and Regulation
1013 Section 13 of Revised Regulations of Ontario, 1990 made under the Retail Sales Tax Act, as amended.

We, (Name of Recipient)
of the (City, Town, etc.)
of (Name of City, Town, etc.)
in the (County, Regional Municipality, etc.)
of (Name of County, Regional Municipality, etc.) ,
Province of Ontario and (Name of Donor)
of the(City, Town, etc.)
of (Name of City, Town, etc.)
in the (County, Regional Municipality, etc.)
of (Name of County, Regional Municipality, etc.) , Province of Ontario,

MAKE OATH AND SAY:

We have personal knowledge of the matters stated below.
The Recipient is now the owner of the Used Vehicle(s) named in the Application(s) for Transfer.
The Used Vehicle(s) owned by the said Recipient is/are a
(Year) (yyyy)
(Make)
(Model)
bearing Vehicle Identification Number
If more than 1 vehicle is being transferred attach list including Year, Make, Model and VIN Number.
The Used Vehicle(s) was/were acquired by the said (Name of Owner/Recipient) on (Dateyyyy/mm/dd)
from (Name of Donor)
as the result of (Reason(s))
The detailed reason(s) for the transfer of the Used Vehicle(s) was/were

SWORN before me

at the (City, Town, etc.)
of (Name of City, Town, etc.)
in the (County, Regional Municipality, etc.)
of (Name of County, Regional Municipality, etc.)
this (day) of (month) (year)
* A Commissioner, etc.

Note: When claiming an exempt transfer of used vehicles between Corporations, or between a Corporation and Shareholder, attach to the sworn statement an information Addendum which may be obtained from the ServiceOntario Centre/Driver and Vehicle License Issuing Office.

(Signature of Recipient)

(Signature of Donor)

* Commissioner may be:

Lawyer/Notary Public
Justice of the Peace
Local municipal/town Clerk, Deputy Clerk, Treasurer, Head of Municipal
Council, Reeve/Deputy
Others appointed by Lieutenant Governor to administer oaths and to take affidavits (call 1-866-668-8297 for availability of a Commissioner)

WARNING: Every person who knowingly makes a false or deceptive statement herein is guilty of an offence and is liable on conviction to
a fine, or term of imprisonment, or both (Retail Sales Tax Act, Subsections 32(4) and 32(4.1)).

Personal information is collected on this form under authority of subsection 4.2(8) of the Ontario Retail Sales Tax Act, R.S.O. 1990, c.R.31, (as amended) and may be used to determine eligibility for retail sales tax exemption. Questions about this collection should be directed to: Ministry of Finance, 33 King Street West, PO Box 623, Oshawa ON L1H 8H7, 1 866 668-8297.