Form MVU-23 Affidavit in Support of a Claim for Exemption From Sales or Use Tax for a Motor Vehicle, Trailer or Other Vehicle Transferred to an Insurer - Massachusetts

Form MVU-23 is a Massachusetts Department of Revenue form also known as the "Affidavit In Support Of A Claim For Exemption From Sales Or Use Tax For A Motor Vehicle, Trailer Or Other Vehicle Transferred To An Insurer". The latest edition of the form was released in November 1, 2018 and is available for digital filing.

Download an up-to-date Form MVU-23 in PDF-format down below or look it up on the Massachusetts Department of Revenue Forms website.

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Form MVU-23
Rev. 11/18
Affidavit in Support of a Claim for Exemption
Massachusetts
from Sales or Use Tax for a Motor Vehicle,
Department of
Trailer or Other Vehicle Transferred to an Insurer
Revenue
This claim for exemption is based on a transfer to an insurer by an insured in connection with a claim for the loss or loss of use of the vehicle
under an insurance policy. Read the instructions on the next page before completing this form and provide the following information. All
entries must be printed or typed ex cept for signature.
Fill in if attaching multiple Forms MVU-23, a spreadsheet or statement.
Motor Vehicles Transferred
Vehicle identification
Year
Make
Model
number
Title number
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Declaration
I certify that each vehicle described in this affidavit, and each vehicle described in any attachments, was transferred in connection with a
claim under an insurance contract for loss or loss of use. I declare under the pains and penalties of perjury that I have reviewed this affidavit
and that the statements I have made in it are true.
Authorized representative of insurer (print)
Signature of representative
Date
Name and address of insurer
City/Town
State
Zip
Form MVU-23
Rev. 11/18
Affidavit in Support of a Claim for Exemption
Massachusetts
from Sales or Use Tax for a Motor Vehicle,
Department of
Trailer or Other Vehicle Transferred to an Insurer
Revenue
This claim for exemption is based on a transfer to an insurer by an insured in connection with a claim for the loss or loss of use of the vehicle
under an insurance policy. Read the instructions on the next page before completing this form and provide the following information. All
entries must be printed or typed ex cept for signature.
Fill in if attaching multiple Forms MVU-23, a spreadsheet or statement.
Motor Vehicles Transferred
Vehicle identification
Year
Make
Model
number
Title number
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Declaration
I certify that each vehicle described in this affidavit, and each vehicle described in any attachments, was transferred in connection with a
claim under an insurance contract for loss or loss of use. I declare under the pains and penalties of perjury that I have reviewed this affidavit
and that the statements I have made in it are true.
Authorized representative of insurer (print)
Signature of representative
Date
Name and address of insurer
City/Town
State
Zip
Form MVU-23 Instructions
The purchaser of a motor vehicle acquired for use, storage or other
Your statements apply to each vehicle included in this affidavit, and
consumption in the Commonwealth of Massachusetts is required
any attachments, and are made under the pains and penalties of
to pay a sales or use tax unless an exemption is specifically pro-
perjury. A statement which is made willingly and is false as to a
vided for in the Massachusetts General Laws or the Code of Mass-
material matter may be punished as a felony under MGL ch 62C,
achusetts Regulations.
§73, or MGL ch 268, § 1A. Perjury is a serious crime and punish-
ment can be severe.
Massachusetts law provides for an exemption from the sales or use
tax for transfers by an in sured in connection with a claim under an
If you have any questions about the acceptance or use of this affi-
insurance contract for the loss or loss of use of the vehicle. In order
davit, contact Massachusetts Department of Revenue, Trustee
to be exempt from the sales or use tax you must meet the require-
Tax Bureau, PO Box 7010, Boston, MA 02204, (617) 887-MDOR.
ments of the law and complete and sign Form MVU-23. If you have
additional vehicles, you may submit more than one Form MVU-23,
or a spreadsheet listing the year, make, model, VIN and title num-
ber of each additional vehicle. Include on each page the name and
address of the insurance company and the date. Be sure to fill in the
oval at the top of Form MVU-23 if submitting more than one form
or attaching a spreadsheet.

Download Form MVU-23 Affidavit in Support of a Claim for Exemption From Sales or Use Tax for a Motor Vehicle, Trailer or Other Vehicle Transferred to an Insurer - Massachusetts

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