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Application for Certificate of Title With/Without …

8 motor vehicle identification number verification this section requires a physical inspection and a verification of the vehicle identification number (vin) (or the motor number for motor vehicles manufactured


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Text of Application for Certificate of Title With/Without …

STATE OF FLORIDADEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTOR VEHICLESNEIL KIRKMAN BUILDING - TALLAHASSEE, FL 32399-0610APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATIONAPPLICATION TYPE: ORIGINAL TRANSFERVEHICLE TYPE: OFF-HIGHWAY VEHICLE MOTOR VEHICLE MOBILE HOME VESSEL1OWNER / APPLICANT INFORMATIONCustomer NumberUnit NumberFleet Number OR AND NOTE: When joint ownership, please indicate if or or and is to be shown on title when issued. If neither box is checked, the title will be issued with and .Owner s First Name, Full Middle/Maiden Name, Last NameDate of BirthSexFL Driver License or FEID/Suffix NumberCo-Owner s First Name, Full Middle/Maiden Name, Last NameDate of BirthSexFL Driver License or FEID/Suffix NumberLessee s First Name, Full Middle/Maiden Name, Last NameDate of BirthSexFL Driver License or FEID/Suffix NumberOwner s Mailing Address(Mandatory)CityStateZipCo-Owner s or Lessee s Mailing Address (Mandatory)CityStateZipOwner s or Lessee s Physical Street Address in Florida (Mandatory)CityStateZipPhysical Address of Mobile Home (if applicable) Check if mobile home is in a park with 10 or more lots CityStateZipMail To Customer Name (If different From Above Owner)Date of BirthSexFL Driver License or FEID/Suffix NumberMail To Customer Address (If different From Above Mailing Address)CityStateZip2MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTIONVehicle/Vessel Identification NumberMake/ManufacturerYearBodyColorFlor ida Title NumberPrevious State of IssueLicense Plate or Vessel Registration NumberWeightLengthFt. Current Date of IssueTYPE Open Motorboat Houseboat Personal Watercraft Cabin Motorboat Pontoon Canoe Auxiliary Sailboat Airboat Other _________ Inflatable Sailboat SpecifyHULL MATERIAL Wood Aluminum Fiberglass Steel Wood/Fiberglass Other_____________________ SpecifyPROPULSION Outboard Sail Inboard Air Propelled Inboard/Outboard Other_____________________ SpecifyFUEL Gas Diesel Electric Other_____________ Specify*DRAFT OF VESSEL(The depth of water a vessel draws)FT. ______ IN. _______*For all vessels 26 or more inlength and all sailboatsUSE OF VESSEL Recreational (Pleasure) Commercial Blue Crab Commercial Stone Crab Dealer/Manuf. Commercial Fish Commercial Live Bait Commercial Shrimp Recip. Exempt Hire (Livery) Commercial Mackerel Commercial Shrimp Non-Recip. Government Commercial Sponge Commercial Oyster Commercial Spiney Lobster Commercial Charter Commercial OtherOwnerCo-OwnerAre you a Florida resident?yes noyes noAre you an alien?yes noyes noPREVIOUSOUT-OF-STATEREGISTRATION NUMBER:Previously Federally Documented Vessel, Attach Copy of: Coast Guard Release From Documentation Form; or Copy of Canceled Documentation PapersState of Principal Use3BRANDS, USAGE AND TYPE (Check Applicable Boxes)SHORT TERM LEASE LONG TERM LEASEREBUILTPOLICE VEHICLEPRIVATE USETAXI CABFLOOD VEHICLEILEV VEHICLE ASSEMBLED FROM PARTS REPLICAKIT CAR GLIDER KIT MANUFACTURER S BUY BACKELECTRIC VEHICLE4LIENHOLDER INFORMATIONCHECK IFELT CUSTOMER FEID # or DL # and Sex and Date of BirthDate of LienLienholder's NameLienholder's AddressCityStateZipIf Lienholder authorizes the Department to send the motor vehicle or mobile home title to the owner, check box and countersign: ________________________________________ _______________________________(Does not apply to vessels). If box is not checked, title will be mailed to the first lienholder.(Signature of Lienholder s Representative)5TRANSFER TYPEIF OWNERSHIP HAS TRANSFERRED, HOW AND WHEN WAS THE VEHICLE, MOBILE HOME, OR VESSEL ACQUIRED? SALE GIFT REPOSSESSION COURT ORDER OTHER (SPECIFY) ________________________________________ __DATE ACQUIRED _________/___________/______________6ODO METER DECLARATIONWARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing a false statement may result in fines or STATE THAT THIS MOTOR VEHICLE S 5 DIGIT OR 6 DIGIT ODOMETER NOW READS , .XX (NO TENTHS) MILES, DATE READ __ __/__ __/__ __, AND TO THE BESTOF MY KNOWLEDGE THAT IT REFLECTS THE ACTUAL MILEAGE OF THE VEHICLE DESCRIBED IN THIS DOCUMENT UNLESS ONE OF THE FOLLOWING IS CHECKED:CAUTION: 1. I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, THE ODOMETER READING REFLECTS THE AMOUNT OF MILEAGE IN EXCESS OF ITS MECHANICAL NOT CHECKIF ACTUAL MILEAGE 2. I HEREBY CERTIFY THAT THE ODOMETER READING IS NOT THE ACTUAL MILEAGE. WARNING -- ODOMETER DISCREPANCY7DEALER SALES TAX REPORTFLORIDA SALES TAX REGISTRATION NUMBERDATE OF SALEDEALER LICENSE NUMBERAMOUNT OF TAXDEALER / AGENT SIGNATUREHSMV 82040 (REV. 10/03) S VEHICLE IDENTIFICATION NUMBER VERIFICATIONTHIS SECTION REQUIRES A PHYSICAL INSPECTION AND A VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER (VIN) (OR THE MOTOR NUMBER FOR MOTOR VEHICLES MANUFACTUREDPRIOR TO 1955) OF THE MOTOR VEHICLE DESCRIBED ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, OR FLORIDA DIVISION OF MOTOR VEHICLESEMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE VIN IS VERIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER, THE VERIFICATION MUST BE SUBMITTED ON THEIR LETTERHEADSTATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING TRAILERS, (WITH ABBREVIATION OF "TL" WITH A WEIGHT OF 2,000 POUNDS OR MORE) NOT CURRENTLYTITLED IN , the undersigned, certify that I have physically inspected the above described vehicle and find the vehicle identification number to be: (Vehicle Identification Number)_________________________________ _ ________________________________________ ___________________________________ ________________________________________ ________________________________________ _____________ DATE SIGNATUREPRINTED NAMELaw Enforcement Officer or Florida Dealer's Name ________________________________________ _______________ Badge # or Florida Dealer # ______________________ Notary Stamp or SealFL DMV/Tax Collector Employee ________________________________________ ______ Florida Compliance Examiner/Inspector Badge or ID Number___________________________COMMISS IONED NAME OF FLORIDA NOTARY: ________________________________________ __________ NOTARY'S SIGNATURE ________________________________________ _________ (Print, Type or Stamp)9SALES TAX EXEMPTION CERTIFICATIONTHE PURCHASE OF A RECREATIONAL VEHICLE TO BE OFFERED FOR RENT AS LIVING ACCOMMODATIONS DOES NOT QUALIFY FOR EXEMPTION. I CERTIFY THE RECREATIONAL VEHICLE, MOBILE HOME OR VESSEL DESCRIBED HAS BEENPURCHASED AND IS EXEMPT FROM THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, BY: PURCHASER (STATE AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATECONSUMER S CERTIFICATE OF EXEMPTION NUMBER MOTOR VEHICLE MOBILE HOME VESSEL WILL BE USED EXCLUSIVELY FOR RENTALSALES TAX REGISTRATION NUMBERI hereby certify that ownership of the motor vehicle, mobile home or vessel described on this application, is not subject to Florida Sales and Use Tax for the following reason: INHERITANCE GIFT DIVORCE DECREE TRANSFER BETWEEN HUSBAND AND WIFE EVEN TRADE OR TRADE DOWN (State the facts of the even trade or trade down and the transferor information, including the transferor's name and address, below under "Other: Explain.") OTHER: (EXPLAIN)10REPOSSESSION DECLARATIONIF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:I CERTIFY THAT THIS MOTOR VEHICLE, MOBILE HOME OR VESSEL WAS REPOSSESSED UPON DEFAULT IN THE TERMS OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.(VESSEL) A PHOTOCOPY OF THE LIEN INSTRUMENT FOR THE VESSEL IS REQUIRED AND AND OTHER CERTIFICATIONSIF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED. THE VEHICLE IDENTIFIED WILL NOT BE OPERATED ON THE STREETS AND HIGHWAYS OF THIS STATE. THE VESSEL IDENTIFIED WILL NOT BE OPERATED ON THE WATERS OF THIS STATE. OTHER: (EXPLAIN) ________________________________________ ________________________________________ ________________________________________ ___________________________________12APP LICATION ATTESTMENT AND SIGNATURESI/WE PHYSICALLY INSPECTED THE ODOMETER AND I/WE FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS. (More than one form HSMV 82040 may be used for additional signatures.)UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE SIGNATURE OF APPLICANT (OWNER)Date SIGNATURE OF APPLICANT (CO-OWNER) Date13RELEASE OF SPOUSE OR HEIRS INTERESTThe undersigned person(s), state as follows: That ________________________________________ ______ of_________________________ County, Florida died on the ____________ day of_________________________, 20______ testate (with a will) intestate (without a will) and left surviving (him/her) the following beneficiaries:Signature(s) of surviving spouse, co-owner and/or heirs. (More than one form HSMV 82040 may be used for additional signatures.)UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. Print or Type Name of Spouse, Co-owner or Heir(s) Signature of Spouse, Co-Owner or Heir(s)_________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ _______That at the time of death the decedent was owner of the motor vehicle, mobile home or vessel described in section 2 of this form. That the estate is not indebted and the assets of the estate, excluding this motor vehicle,mobile home or vessel are sufficient to pay all just claims and that no probate proceedings have been instituted upon the estate. That the person(s) signing above hereby releases all their right, title, interest and claim as heirsat law, legatees, devisee, or otherwise to the aforesaid motor vehicle, mobile home or vessel to:Name of Applicant(s) (Print or Type)RESIDENTS OF FLORIDA AND ALL VESSEL OWNERS, RESIDING IN FLORIDA OR OUT OF STATE, SHOULD SUBMIT THIS FORM AND ALL REQUIRED DOCUMENTATION TO A LOCAL FLORIDA TAXCOLLECTOR S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR 82040 (REV. 10/03)

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