West Virginia Division of Motor Vehicles · West Virginia state form
DMV-PSA-001 Political Subdivision Affidavit
This affidavit certifies that an agency or department belongs to a specified political subdivision and is entitled to a privilege tax exemption.
- What this form is
- Use DMV-PSA-001 to identify an agency or department as belonging to the state, a county, or a municipality. The form asks for insurance company and organization details, along with the signer’s printed name, department, title, date, and phone number. The signer swears under penalty of perjury to the entity’s status and tax-exemption eligibility. A notary section is included.
- Who needs it
- An agency or department seeking to certify its political-subdivision status and eligibility for the privilege tax exemption described on the form needs this affidavit.
- Why it needs a notary
- The affidavit must be signed before a notary, as it includes a jurat. You can complete this online with a commissioned online notary.
- How to submit it
- Submit it to the West Virginia agency named on the form.
Questions
Who completes the Political Subdivision Affidavit?
An agency or department completes it to certify that it belongs to the state, a county, or a municipality, as selected on the form.
Does the Political Subdivision Affidavit need to be notarized?
Yes. The form includes a “Subscribed and sworn to before me” jurat and a Notary Public section. You can notarize it online with a commissioned online notary.
What information does the affidavit request?
The form requests the political subdivision, insurance company, organization name, and the signer’s printed name, department or agency, title, date, and phone number.