Rev. 3/29/21

New Dealer Packet and Information

Below are the descriptions for the documents included in this packet.

1. Regional office contact information and directions 2. Dealer wait/drop-off procedure for St. Lucie County Tax Collector 3. Dealer Kiosk Information and Procedure – Dealership and Runner applications included 4. Dealer Transaction Worksheet – Required for each wait-on transaction or attach one

per 10 transactions for drop-off. Please complete with dealer’s information, each customer name, tag information, and any notes, if needed. Check appropriate boxes under tag information and clearly print plate number if transferring.

5. Application for Certificate of Title (HSMV 82040) – Application must be completed with original signatures. Forms with error or white out will NOT be accepted. If the title is being printed (mailed or same day title) please check the box in section 1 and complete the Authorization/Release Affidavit in this packet. If the title is from another state, the VIN must be verified in Section 8 and signed by the dealer.

6. Reassignment Supplement (HSMV 82994 – Secure Rainbow Form) – Terms of use are on the back of the form. Any alterations/errors will NOT be accepted. Form must be completed and original submitted. Keep the yellow copy.

7. Motor Vehicle Power of Attorney/Odometer Disclosure (HSMV 82995 - Secured Rainbow Form) – Terms of use are on the back of the form. This is used mostly when a vehicle has been traded in and the title is unavailable. Part A & C must be completed upon trade and Part B completed if the vehicle is sold, by the same dealership, before the title becomes available. Original is submitted, keep the gold/orange copy, and the seller in Part A will keep the yellow.

8. Power of Attorney (HSMV 82053) – This power of attorney may only be used by the dealership when the mileage qualified for exemption. It may also be used when the owner appoints a third party (not affiliated with the dealership in any capacity) as power of attorney.

9. Separate Odometer Disclosure Statement and Acknowledgment (HSMV 82993) – This form is mostly use when there is a discrepancy in the mileage on the title or other documents. When this form is used because of an error made on the mileage, you must also attach an affidavit on the dealership letterhead stating the error that was made. The letter must include the Year/Make/VIN.

10. Replacement License Plate/Decal Application (HSMV 83146) – Needs to be completed any time we need to replace the license plate including if the plate was previously surrendered. Must be completed and signed by the owner.

Rev. 3/29/21

11. Authorization/Release Affidavit – Must be completed and signed by the legal owner of the vehicle or power of attorney to request a fast title. ‘Person Appointed’ is whoever will be picking up the paperwork from our office.

12. EFS Dealer Inventory Request Application – This application must be submitted when requesting inventory such as blank decals and plates. This form may be emailed to the email address below. Inventory requests must be picked up in our Fort Pierce location.

13. Application for Temporary License Plate (HSMV 83090) – This form must be completed to order pre-printed temporary tags for use during ETR outage or for trailers under 2.000 pounds. Tags must be ordered in quantities of 5 (minimum of 25). Please see the procedure RS-31-02 for issuing temporary plates without using an ETR Vendor. The “Application for Off-Line Issuance of Pre-Printed Temporary License Plate” form 82082 is also included in this packet. This form must be returned once a temporary tag has been issued to the customer within 1 business day.

14. Application for Off-Line Issuance of Pre-Printed Temporary License Plate (HSMV 82082)

15. Reassignment Supplement to a Certificate of Title (HSMV 82091) – Used for dealer-to-dealer transfers.

16. Hope Scholarship Program Contribution Election (DR-HS1) – The Hope Scholarship Program provides a public-school student who was subjected to an incident of violence or bullying at school the opportunity to apply for a scholarship to attend an eligible private school rather than remain in an unsafe school environment.

17. License Plate Rate Chart (HSMV 83140) – License plate rates, instructions, and calculations of fees sheet.

18. Florida Insurance Affidavit (HSMV 83330) SPECIAL NOTE: Always verify your documents and make sure everything is completed and accurate before submitting to avoid rejection. Should a transaction be rejected, a clerk may attach a checklist with an explanation for the rejection and how to proceed. All forms in this packet can be found on our website at www.tcslc.com under Services – Online Forms or in the Dealer’s Corner. Contact Information: St. Lucie County Tax Collector: 772-462-1650 Dealer at Walton office: 772-337-5743 Dealer at Fort Pierce: 772-462-3579 Dealer at Tradition: 772-337-5605 Email: dealerinfo@tcslc.com

Rev. 3/29/21

Dealer Drop-off and Wait-On Procedure

Dealer Drop-Off Procedure

• Each Dealer will be required to bring a folder into our office with their work enclosed. Folders with transaction can be dropped off at the dealer desk in each tax collector location

• Dealers can access the “Dealer transaction worksheet” on our website. There is a maximum of ten transactions per worksheet

• The dealer representative must use the dealer kiosk, a mandatory technology for dealers, as well as towing and storage, to easily drop off their paperwork if they are not seeing a customer service representative.

o Every dealer and runner must complete an application before receiving a barcode key tag that identifies them when interacting with the kiosk

o An email address and phone number are both required on each completed dealer and runner application in order to initiate the personalized key tag

o The phone number can be used to gain entry to the kiosk if a key tag is unavailable

o In order to submit new work, the key tag is held under the kiosk’s barcode reader and the account information is then displayed

o Once this information is displayed, the kiosk’s touchscreen will ask two questions:

▪ How many items? ▪ What is the check number?

o When the paperwork is ready for pick up, the system notifies the runner via email and copies the business.

o To retrieve completed items, use the key tag the same as before to select the appropriate items from the kiosk’s touchscreen. The selected items will be marked as pick-up complete

Wait-On Procedure – (A dealer is going to wait for the work to be completed)

• Wait-on transactions will not be processed between o Noon – 2 P.M.

• Each dealer/company will be allowed to do three (3) wait-on transactions per day at the tax collector’s office

o One transaction per clerk, per check

Allowing more than three transactions in the same day will be a supervisor decision

Due to the pandemic, the St. Lucie County Tax Collector is only allowing dealers to drop-off only.

Rev. 3/29/21

Kiosk Drop-Off:

• Press “start new transaction” on the kiosk screen

• Scan the key card or input phone number

• Select the Dealership

• Select Drop-off

• Input number of items per transaction sheet

• Input the check number (For multiple checks, dealers may either input each check or one number for all checks. If dealers want to keep track of multiple checks, each one should be put into the kiosk.) (For credit cards, dealer may enter the last 4 digits)

• Click Submit

NOTE: Dropped off transactions will show up in grey as “In Progress,” on the Dealer Room Administrator tab “Work Manager”.

Kiosk Pickup:

• Press “start new transaction” on the kiosk screen

• Scan the key card or enter the phone number

• Select the dealership

• Select pickup

• Select the transaction that is ready for pickup (if transaction is not ready, it will say “in progress”)

Special Notes:

• One person can be on both applications as a runner and as contact for the business, but they must have different phone numbers when created.

• If there are multiple runners for one dealership, each runner may get their own key card; however, when dropping off the work, it will be put under that runner’s name and key card. If another runner comes in from the same dealership to pick up, they will not be able to log out the work under their own key card number as it will not show.

• Cards are replaceable, but a new runner account must be created for each new card. Old accounts that are not in use or runners that are no longer doing business with the dealership may be deleted as long as there is no work under that runner.

• If a runner cannot find their card and wants to drop-off or pickup, the runner may log in by the phone number that was registered.

Division of Motorist Services Region IX

901 Northpoint Parkway, Suite #115 & 116 West Palm Beach, Florida 33407

Telephone: (561) 640-6820 Fax: (561) 640-6835

Directions: On I-95, Exit #74, 45th Street. If approaching the Exit from I-95 Northbound, turn left (West) onto 45th Street. If approaching the Exit from I-95 Southbound, turn right (West) onto 45th Street. On Northpoint Boulevard turn right. Then turn right on Northpoint Parkway. Follow road around to building 901, turn right into the entrance and immediate right which will take you behind the buildings. On your left you will approach the Division of Motorist Services Office, (located on the corner, facing I-95) For Re-Built appointments: Park directly behind building and use the back entrance to check in.

Runner Application

Please check below if the runner would like to receive text or email notifications or both for completed work.

*The runner's cell number or office extension number will not be used for contact unless they choose to receive text notifications. It will only be used for the runner to look up their account in the event that they do not have their card with them.

For internal use only: Runner verification

Which tax collector's office do you prefer to use? Please check below.

Rev. 6/15/20

Runner name:

Dealership name:

Phone number (cell or office extension - not main number):

Email address:

Employee name ID # Date

Carrier:

Fort Pierce Port Saint Lucie Tradition

Text Notification (must provide carrier) Email Notification Both (must provide carrier)

Dealership Application

Would the dealership like to receive text or email notifications or both for completed work? Please check below.

Which tax collector's office do you prefer to use? Please check below.

Rev. 6/15/20

Dealership Name

Contact Name

Phone Number

Email Address

How many runners do you have? Please list them. A completed application is needed for each runner

Carrier:

Text Notification (must provide carrier) Email Notification Both (must provide carrier)

Fort Pierce Port Saint Lucie Tradition

DEALER TRANSACTION DETAIL WORKSHEETDATE: DEALER/TAG AGENCY NAME:

AMOUNT:CHECK#: PIN: LICENSE #:

TAG INFORMATIONCOMPLETED BY TAX COLLECTOR

TITLE AND SALES TAX INFORMATION

FASTTITLEWITH

AFFIDAVIT

DATE PROCESSED

REJECTED

TRANSFER NEW TAG

2YEAR

CLERK

DUE

SALESTAX

TITLEONLYTRANSFER

ONLYPLATE #

01TO12

MOS.

13TO15

MOS.

RENEW

APPLICANT'S NAME

YES NOYES NOYES NOYES NOYES NOYES NOYES NOYES NOYES NOYES NO

DEALER DEPT. PHONES: FORT PIERCE ~ 772-462-3579 WALTON ~ 772-337-5743 TRADITION ~ 772-337-5602 EMAIL: dealerinfo@tcslc.com

NO MORE THAN 10 TRANSACTIONS

PER CHECK

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Rev 1/30/2020

Comments:

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

CHECK APPLICATION TYPE: ORIGINAL TRANSFER VEHICLE TYPE MOTOR VEHICLE MOBILE HOME : : VESSEL OFF-HIGHWAY VEHICLE ATV ROV MC

1 OWNER / APPLICANT INFORMATION Customer Number Check this box if you are requesting

the certificate of title to be printed. Owner Co-Owner

Are you a Florida resident? yes no yes no

Are you an alien? yes no yes no

Unit Number Fleet Number

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." OR AND If applicable:

Life Estate/Remainder Person Tenancy By the Entirety With Rights of Survivorship

Owner's County of Residence:

_____________________________________ Owner’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name) Owner’s Email Address Date of Birth Sex FL Driver License or FEID/Suffix #

Co-Owner/Lessee’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name) Co-Owner’s/Lessee’s Email Address Date of Birth Sex FL Driver License or FEID/Suffix #

Owner’s Mailing Address (Mandatory unless a member of the Military) City State Zip

Co-Owner’s/Lessee’s Mailing Address (Mandatory unless a member of the Military) City State Zip

Owner’s/Lessee’s Physical Street Address in Florida (Mandatory unless a member of the Military) City State Zip

Mobile Home Physical Address (if applicable) Check if in a mobile home rental park with 10 or more lots.

\\

City State Zip

Mail To Customer Name (If different From Above Owner) Mail To Customer’s Email Address Date of Birth Sex FL Driver License or FEID/Suffix #

Mail To Customer Address (If different From Above Mailing Address) City State Zip

2 MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTION Vehicle/Vessel Identification Number Make/Manufacturer Year Body Color Florida Title Number

Previous State of Issue License Plate or Vessel Registration Number Weight Length Ft. In.

BHP/CC GVW/LOC VAN USE, IF APPLICABLE

PASSENGER OTHER TYPE

Open Motorboat Houseboat Personal Watercraft Cabin Motorboat Pontoon Canoe Auxiliary Sailboat Airboat Other _________ Inflatable Sailboat Specify

HULL MATERIAL Wood Aluminum Fiberglass Steel Wood/Fiberglass Other______________________

Specify

PROPULSION Outboard Sail Inboard Air Propelled Inboard/Outboard Other__________________________

Specify

FUEL Gas Diesel Electric Other_________________

Specify

*DRAFT OF VESSEL (The depth of water a vessel draws)

FT. ______ IN. ______ *For all vessels 26’ or more in length and all sailboats

USE OF VESSEL Recreational (Pleasure) Commercial Blue Crab Commercial Stone Crab Government Commercial Sponge Dealer/Manuf. Commercial Fish Commercial Live Bait Commercial Shrimp Recip. Commercial Charter Commercial Other ______________ Exempt Hire (Livery) Commercial Mackerel Commercial Shrimp Non-Recip. Commercial Oyster Commercial Spiney Lobster

PREVIOUS OUT-OF-STATE REGISTRATION NUMBER:

Previously Federally Documented Vessel, Attach Copy of: U.S. Coast Guard Release From Documentation Form; or Copy of Canceled Documentation Papers

State of Principal Use

3 BRANDS, USAGE AND TYPE (Check Applicable Boxes) SHORT TERM LEASE ASSEMBLED FROM PARTS

LONG TERM LEASE BONDED TITLE

REBUILT KIT CAR

POLICE VEHICLE GLIDER KIT

PRIVATE USE MANUF. BUY BACK

TAXI CAB REPLICA

FLOOD AUTONOMOUS

ILEV

ELECTRIC

CUSTOM

STREET ROD 4 LIENHOLDER INFORMATION CHECK IF ELT CUSTOMER

FEID # DL # and Sex and Date of Birth DMV Account # Date of Lien Lienholder's Name

Lienholder’s Email Address Lienholder's Address City State Zip

________________________________________________________________________ If 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)

5 TRANSFER TYPE

IF OWNERSHIP HAS TRANSFERRED, HOW AND WHEN WAS THE VEHICLE, MOBILE HOME, OR VESSEL ACQUIRED?

SALE GIFT REPOSSESSION COURT ORDER OTHER (SPECIFY) __________________________________________ DATE ACQUIRED _________/___________/______________

6 ODOMETER DECLARATION

WARNING: 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 imprisonment.

I/WE STATE THAT THIS 5 OR 6 .XX (NO TENTHS) _____ /_____ / ________ DIGIT ODOMETER NOW READS MILES, DATE READ AND I/WE HEREBY CERTIFY THAT TO THE BEST OF MY/OUR KNOWLEDGE THE ODOMETER READING:

1. REFLECTS ACTUAL MILEAGE. 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3. IS NOT THE ACTUAL MILEAGE.

7 DEALER SALES TAX REPORT AND VEHICLE TRADE IN INFORMATION (IF APPLICABLE)

FLORIDA SALES TAX REGISTRATION NUMBER DATE OF SALE DEALER LICENSE NUMBER AMOUNT OF TAX DEALER / AGENT SIGNATURE

YEAR OF TRADE IN MAKE OF TRADE IN TITLE NUMBER OF TRADE IN (IF KNOWN) VEHICLE IDENTIFICATION NUMBER OF TRADE IN

HSMV 82040 – REV. 11/15 RULE 15C-21.001, FAC www.flhsmv.gov

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 PRIOR TO 1955) OF THE MOTOR VEHICLE DESCRIBED ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, OR FLORIDA DIVISION OF MOTOR VEHICLES EMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE VIN IS VERIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER, THE VERIFICATION MUST BE SUBMITTED ON THEIR LETTERHEAD STATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING TRAILERS, (WITH ABBREVIATION OF "TL" WITH A WEIGHT OF 2,000 POUNDS OR MORE) NOT CURRENTLY TITLED IN FLORIDA. I, t

he undersigned, certify that I have physically inspected the above described vehicle and find the vehicle identification number to be: (Vehicle Identification Number)

DATE SIGNATURE PRINTED NAME

Law Enforcement Officer or Florida Dealer/Agency Name Badge # or Florida Dealer # Notary Stamp or Seal

FL DMV/Tax Collector Employee _ Florida Compliance Examiner/Inspector Badge or ID Number_

COMMISSIONED NAME OF FLORIDA NOTARY: _____________________________(Print, Type or Stamp)

NOTARY'S SIGNATURE

9

SALES TAX EXEMPTION CERTIFICATION THE 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 BEEN PURCHASED AND IS EXEMPT FROM THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, BY:

CONSUMER’S CERTIFICATE OF EXEMPTION NUMBER PURCHASER (STATE AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE

MOTOR VEHICLE MOBILE HOME VESSEL WILL BE USED EXCLUSIVELY FOR RENTAL SALES TAX REGISTRATION NUMBER

I 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 A MARRIED COUPLE 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)

10 REPOSSESSION DECLARATION IF 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 ATTACHED.

I AM REQUESTING THAT AN ORIGINAL CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME IN LIEU OF A TITLE (REPOSSESSION).

I AM REQUESTING THAT A DUPLICATE CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME, AS THE ORIGINAL HAS BEEN LOST OR DESTROYED.

11 NON-USE AND OTHER CERTIFICATIONS IF 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 UNTIL PROPERLY REGISTERED.

THE VESSEL IDENTIFIED WILL NOT BE OPERATED ON THE WATERS OF THIS STATE UNTIL PROPERLY REGISTERED.

OTHER: (EXPLAIN)

12 APPLICATION ATTESTMENT AND SIGNATURES I/WE PHYSICALLY INSPECTED THE ODOMETER/VIN AND 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 FORE

GOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

SIGNATURE OF APPLICANT (OWNER) Date SIGNATURE OF APPLICANT (CO-OWNER) Date

13 RELEASE OF SPOUSE OR HEIRS INTEREST

The undersigned person(s) state(s) as follows: That

(Name of Deceased) died on

(Date)

testate (with a will) intestate (without a will) and left the surviving heir(s) named below. When applicable, the heir(s) (named below) certifies that the certificate of title is lost or destroyed.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. (More than one form HSMV 82040 may be used for additional signatures.)

__________________________________ ___________________________________________________________________________ _____________________________________________________________________________________________

_________________________________________________________________________________________________ _________________________________________________________________________________________________

________________________________________________________________________________ ________________________________________________________________________________

________________________________________________________________________________ ________________________________________________________________________________

________________________________________________________________________________ ________________________________________________________________________________

_______________________________________________________ ______________________

_____________________________________________ __________________________

_____________________ _________________________________________________

_________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________ _____________________________.

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. The person(s) signing above hereby releases all of his/her/their right, title, interest and claim as heir(s) at law, legatee(s), devisee(s), 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 TAX COLLECTOR’S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR PROCESSING. Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

www.flhsmv.gov HSMV 82040 – REV.

11/15 RULE 15C-21.001, FAC

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR

VEHICLES DIVISION OF MOTORIST SERVICES Neil Kirkman Building - Tallahassee, FL 32399-0500

MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT (Instructions on Reverse Side)

Title No.: State of Issue: Manufacturer’s Statement or Certificate of Origin

This reassignment is supplement to:

Is the title electronic? Yes No VEHICLE DESCRIPTION

Vehicle Identification Number Year Make Model Body

REASSIGNMENT INFORMATION

Name of Seller(s)/Agent (Print) DL/ID#, DMS ACCT#, FEID# DEALER/AUCTION LICENSE (if applicable)

Street Address City State Zip

Selling Price (If Applicable) Sales Tax Collected (If Applicable) Sales Tax Reg. No. (If Applicable)

Purchaser and Co-Purchaser's Printed Name(s) Date of Sale

Purchaser’s Address City State Zip

Co-Purchaser’s Address (If applicable) City State Zip

Auction Name (If applicable) Auction License Number State of License Date of Auction

Street Address City State Zip

ODOMETER DISCLOSURE STATEMENT

WARNING: FEDERAL AND STATE LAW REQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

I/WE STATE THAT THIS 5 OR 6 DIGIT ODOMETER NOW READS, , XX (NO TENTHS) MILES, DATE READ , AND I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING.

CAUTION: READ CAREFULLY BEFORE YOU CHECK A BOX

1 ) REFLECTS ACTUAL MILEAGE 2) IS IN EXCESS OF ITS MECHANICAL LIMITS 3) IS NOT THE ACTUAL MILEAGE.WARNING - ODOMETER DISCREPANCY

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

Printed name of seller(s)/Agent Seller(s)/Agent Signature

Purchaser(s) Printed Name First, Full Middle or Maiden, Last Co-Purchaser(s) Printed Name First, Full Middle or Maiden, Last

NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS ASSIGNMENT AND ALL ASSIGNMENTS THAT FOLLOW.

ORIGINAL: SUBMIT WITH APPLICATION FOR TITLE

HSMV 82994 (REV. 04/14) S COPY: SELLER/DEALER RETAIN IN FILE

Purchaser(s) Signature Co-Purchaser(s) Signature

Printed name of Co-Seller (If applicable) Co-Seller Signature (If applicable)

SAMPLE

must b

e fille

d out

by ha

nd

HSMV 82994 (REV. 04/14) S

WHEN SHOULD THIS FORM BE USED?

FORM HSMV 82994, MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT, MUST BE USED:

1. with conforming Florida Certificate(s) of Title to make additional dealerreassignments and odometer disclosures when all reassignment and odometerdisclosure spaces on the reverse side of the Certificate of Title have been used:

OR

2. with a non-conforming Certificate(s) of Title to make reassignments and odometerdisclosures;

OR

3. with conforming MCO, when the MCO is not available at the time of sale;

OR

4. with all out-of state non-conforming Certificate(s) of Title to make dealerreassignments and odometer disclosures;

OR

5. when ownership is being transferred on an Electronic Certificate(s) of Title.

NOTE: This form should NOT be used wen the owner is transferring ownership on a vehicle that does not have an electronic Certificate of Title. If the Certificate of Title is NOT electronic, the “Transfer of Title By Seller” section must be completed by the seller(s)/agent.

FILING:

1. The original HSMV 82994 is to be surrendered with the application for title.

2. The copy of the HSMV 82994 is to be retained by the dealer in his/her records for aperiod of five (5) years. It is recommended that the individual seller(s) retain a copy ofthis form for their records.SAMPLE

must b

e fille

d out

by ha

nd

- -

- -

MY/OUR KNOWLEDGE THE ODOMETER READING:

- -

10/11)S

WHO IS AUTHORIZED TO USE THIS FORM?:

OWNERS (SELLERS) TRANSFERRING THEIR OWNERSHIP IN THE MOTOR VEHICLE DESCRIBED ON THIS FORM TO A PURCHASER WHO WILL USE THIS POWER OF ATTORNEY TO MAKE A REQUIRED ODOMETER DISCLOSURE ON BEHALF OF THE SELLER (SELLERS MUST COMPLETE PART A WHEN TITLE IS NOT AVAILABLE FOR ODOMETER DISCLOSURE.)

PURCHASERS OBTAININGOWNERSHIP OF THE MOTOR VEHILCE DESCRIBED ON THIS FORM FROM A LICENSED MOTOR VEHILCE DEALER WILL USE THIS POWER OF ATTORNEY TO MAKE A REQUIRED ODOMETER DISCLOSURE ON BEHLAF OF THE PURCHASER. (PURCHASER MUST COMPLETE PART B WHEN THE TITLECERTIFICATE IS NOT AVAILABLE AND PART A HAS BEEN COMPLETED.)

DEALERS LICENSED IN THE STATE OF FLORIDA TO BUY AND SELL MOTOR VEHICLES WILL USE THE POWER(S) OF ATTORNEY TO MAKE REQUIRED ODOMETER DISCLOSURES FOR MOTOR VEHICLE SELLERS AND/OR PURHCHASERS. (DEALERS MUST ALWAYS COMPLETE PART C.)

THIS FORM SHOULD BE USED:

WHEN THE CERTIFICATE OF TITLE IS PHYSCIALLY HELD BY A LIENHOLDER AND IS NOT AVAILABLE FOR ENDORSEMENT FOR TRANSFER AND ODOMETER DISCLOSURE.

WHEN THE CERTIFICATE OF TITLE HAS BEEN LOST OR DESTROYED AND IS NOT AVAILABLE FOR ENDORSEMENT FOR TRANSFER AND ODOMETER DICLOSURE.

THIS FORM IS NOT REQUIRED:

WHEN THE MOTOR VEHICLE IS EXEMPT FROM THE ODOMETER DISCLOSURE REQUIREMENTS UNDER FEDERAL AND STATE LAW. THESE EXEMPTIONS ARE:

- MOTOR VEHICLE IS TEN (10) YEARS OLD OR OLDER- MOTOR VEHICLE IS NOT SELF PROPELLED- MOTOR VEHICLE HAS A GROSS VEHICLE WEIGHT RATING (GVWR) OF MORE

THAN 16,00 POUNDS.

NOTE: IF A POWER OF ATTORNEY FORM IS NEEDED FOR AN EXEMPT VEHICLE (SEE ABOVE LIST OF EXEMPTONS), USE FORM HSMV 82053.

FILING OF COPIES:

ORIGINAL: TO BE ATTACHED TO THE CERTIFICATE OF TITLE WHEEN OBTAINED AND IS TO REMAIN WITH THE TITLE UNTIL THE APPLICATION FOR TITLE IS MADE FOR THE PURCHASER.

SECOND COPY: TO BE RETAINED BY THE DEALER FOR A PERIOD OF FIVE (5) YEARS.

THIRD COPY: TO BE GIVEN TO THE SELLER WHO COMPLETED THE POWER OF ATTORNEY IN PART A.

NOTE: IF THE MOTOR VEHICLE IS BEING SOLD TO AN OUT OF STATE PURCHASER OR AN OUT OF STATE DEALER, THE FLORIDA DEALER MUST PHOTOCOPY THE COMPLETED ORIGINAL OF THIS FORM AND MAIL DIRECTLY TO THE DEPARTMENT WITHIN FIVE (5) BUSINESS DAYS AFTER THE CERTIFICATE OF TITLE AND DEALER REASSIGNMENT FORM ARE DELIVERED BY THE DEALER TO ITS PURCHASER.

(Cit(City) y)

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES- DEVISIONOF MOTORIST SERVICES

flh s/

(Date)

I/We hereb_ name and ap om e my/our Ir- I I

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CHECK ONE: □ tor Vehicle □ bile Hom □ el

Year Make/Manufacturer Body ype Ille Number

1cleNessel ldent1ficat1on

UNDER PENAL TIES OF PERJURY. I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

(Signal ,f Own !r antor") (Legibly Pnnted N ,f n r "Gr ntor")

(Dnv r Lie nse ldont1ficat1on Card or FEID Num , r Own !r) (Dato of 811 r Own !r 1pphcable)

(Own r s A Jress) (City) State) (Zip)

(Signal ,f Co-O n !r antor, If apphcable) (Legibly Pr nted Name J-Own r ntor • 1f apphcable)

(Dnv r Lie nse Id nt1ficat1on Card or FEID Numt ,r Co Own !r) (Dat of 811 r Co-O n !r pphcabl )

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(a)

lb_\

NOTE:

the title IS physically being held by the henholde,; or

the title IS lost

licensed dealer and hrs/her employees are considered a single entity.

STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES – DEVISIONOF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL

(Date)

I/We hereby name and appoint, , to be my/our (Full Legibly Printed Name is Required)

lawful attorney-in-fact, to act for me/us, in applying for an original or duplicate certificate of title, to register, transfer title, or record a lien to the motor vehicle, mobile home or vessel described below, and to print my/our name and sign their name, in my/our behalf. My attorney-in-fact can also do all things necessary to the application or any other relatedinstrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do, were I/we personally present and signing the same.

With full power of substitution and revocation, I/we hereby ratify and confirm whatever my/our said attorney-in-fact may lawfully do or cause to be done in the virtue hereof.

CHECK ONE: Motor Vehicle Mobile Home Vessel

Year Make/Manufacturer Body Type Title Number

Vehicle/Vessel Identification Number

NOTICE TO OWNER(S): COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.

UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

(Signature of Owner "Grantor”) (Legibly Printed Name of Owner "Grantor")

(Driver License, Identification Card or FEID Number for Owner) (Date of Birth for Owner, if applicable)

(Owner’s Address ) (City) State) (Zip)

(Signature of Co-Owner "Grantor,” if applicable) (Legibly Printed Name of Co-Owner "Grantor," if applicable)

(Driver License, Identification Card or FEID Number for Co-Owner) (Date of Birth for Co-Owner, if applicable)

((Co-OCo-Own wner’.r ss Addressress) ) (Zip) (Zip) ((State) State)

This non-secure power of attorney form may be used when an individual or entity appointed as the attorney-in-fact will be completing the odometer disclosure statement as the buyer only or the seller only. However, this form cannot be used to allow an individual or entity (such as a dealership) to sign as both buyer and seller for the purpose of disclosing the odometer reading. This may be accomplished only with the secure power of attorney (HSMV 82995) when:

(a) the title is physically being held by the lienholder; or

(b) the title is lost.

NOTE: A licensed dealer and his/her employees are considered a single entity.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 82053 (Rev. 12/11) S www.flhsmv.gov

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE

www.flhsmv.gov/offices/

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

VEHICLE DESCRIPTIONVehicle Identification Number

Year Make Color Body Title Number

ODOMETER DISCLOSURE STATEMENT

WARNING: 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 and/or imprisonment.

WE STATE THAT THIS 5 or 6 DIGIT ODOMETER NOW READS , .XX (NO TENTHS) MILES,

DATE READ ________/_______/________, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE

ODOMETER READING:

1. REFLECTS ACTUAL MILEAGE.

2. IS IN EXCESS OF ITS MECHANICAL LIMITS.(EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)

3. IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DISCREPANCY

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

Seller’s Signature Seller’s Printed Name

Seller’s Street Address

City State Zip

Buyer’s Signature Buyer’s Printed Name

Buyer’s Street Address

City State Zip

WHO IS AUTHORIZED TO COMPLETE THIS FORM?

ANY PERSON WHO IS BUYING OR SELLING A MOTOR VEHICLE AND WHO MUST MAKE OR ACKNOWLEDGE AN ODOMETER DISCLOSURE, IN ORDER TO COMPLY WITH STATE OR FEDERAL ODOMETER DISCLOSURE LAW.

WHEN SHOULD THIS FORM BE USED?

1. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN SOLD. 2. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN PURCHASED. 3. WHEN AN ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT BETWEEN THE BUYER AND THE SELLER IS

REQUIRED, BUT NO ODOMETER DISCLOSURE STATEMENT HAS BEEN MADE ON ANOTHER STATE OR FEDERAL FORM.

WHEN SHOULD THIS FORM NOT BE USED?

1. WHEN A FLORIDA TITLE WHICH WAS ISSUED ON OR AFTER APRIL 29, 1990 IS AVAILABLE. 2. WHEN A FORM HSMV 82994, MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT, HAS BEEN USED. 3. WHEN A FORM HSMV 82995, MOTOR VEHICLE DEALER POWER OF ATTORNEY/ODOMETER DISCLOSURE, HAS BEEN USED. 4. WHEN AN OUT-OF-STATE TITLE, WHICH CONFORMS TO FEDERAL LAW, IS USED TO TRANSFER A MOTOR VEHICLE.

FILING:

1. COPIES SHOULD BE EXCHANGED BETWEEN THE SELLER AND THE BUYER. DEALERS MUST RETAIN THIS DOCUMENT IN THEIR RECORDS FOR A PERIOD OF FIVE YEARS.

2. IT IS NOT NECESSARY TO FILE THIS FORM OR ANY COPY OF THIS FORM WITH THE STATE OF FLORIDA, UNLESS REQUESTED TO DO SO BY THE DIVISION OF MOTORIST SERVICES.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/ HSMV 82993 (REV. 11/11)

CAUTION: Read carefully before

checking a box.

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES – MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE

https://www.flhsmv.gov/locations/

APPLICATION FOR REPLACEMENT LICENSE PLATE, VALIDATION DECAL OR PARKING PERMIT (Instructions on Reverse Side)

1 REPLACEMENT TYPE REPLACEMENT REASON Check applicable box below: Check applicable box below:

License Plate Damaged Surrendered Seized Decal Defaced Stolen (see back) License Plate and Decal Lost Stolen/Police Report Disabled Person Long-Term Parking Permit Disabled Person Temporary Parking Permit HOV (High Occupancy Vehicle) Decal

Lost-in-transit (applied for and never received) Voluntary (specific reason for replacement)

Please contact your Local County Tax Collector's Office or License Plate Agent for fee information.

2 OWNER / CUSTOMER IDENTIFICATION

(Owner’s or Lessee’s Name) (Driver License Number)

(Street Address)

(City) (State) (Zip)

3 VEHICLE / VESSEL / MOBILE HOME INFORMATION (a)

(Vehicle / Hull / Mobile Home Identification Number) (Year) (Make)

(b)

(Previous License Plate Number) (Previous Decal Number) (Previous Parking Placard Number)

4 ATTESTMENT

I hereby certify under the penalty of perjury that the license plate, decal or permit for the vehicle, vessel, or mobile home listed in Section 3 (a), is no longer or has never been in my possession for the reason checked in Section 1. All information herein is true and correct to the best of my knowledge.

(Owner/Applicant’s Signature) (Date)

Complete the following, if applicable:

was surrendered to the tax collector: (License Plate, Decal, or Parking Permit Number) (County) (Agency)

(Signature of Agency Personnel) (Date)

HSMV 83146 (Rev. 3/19) www.flhsmv.gov

Provision of Law: PROCEDURES AND INSTRUCTIONS

Section 320.0607, Florida Statutes, provides for the replacement of license plates and validation decals when the original license plate or decal has been lost, stolen, defaced, damaged or lost in transit. Application Requirements for a Replacement License Plate, Decal or Parking Permit: Application for a replacement license plate, validation decal or parking permit should be submitted to the local county tax collector's office or license plate agency for processing. However, if the application is for a "special license plate" not issued in the tax collector's office or license plate agency, it must be submitted to the Division of Motorist Services, Direct Mail, MS# 72, Neil Kirkman Building, Tallahassee, FL 32399. 1. Form HSMV 83146, Application for Replacement License Plate, Validation Decal, or Parking Permit,

accurately completed, by the owner/lessee. (Form HSMV 83146 must be completed for everyreplacement request)

2. Contact your local county tax collector's office or license plate agency for fee information.3. For Mail requests, also include copy of the Florida vehicle registration certificate.

Types of Replacement License Plates, Decals, and Permits Voluntary Replacement at time of Renewal: An owner may, at any time during the registration period, replace a license plate, decal or parking permit. The replacement license plate fee is required in addition to the regular registration renewal fee, if the registration has expired. Damaged: A damaged license plate is when the license plate has sustained physical damage. Example: A boat trailer struck the license plate and dented the letters or numbers, customer has waxed or pressure-washed the letters off of the license plate, etc. Replacement fees are required, unless law enforcement has issued a citation to the customer. If a citation has been issued, the owner must surrender the damaged license plate to a local county tax collector's office or license plate agency (along with a copy of the citation) to obtain a replacement at no fee. Defaced: A defaced license plate is when the license plate has not sustained physical damage, but is unreadable for some other reason. Example: The sun has faded the letters or numbers on the license plate. Replacement fees are required, unless law enforcement has issued a citation for the defaced license plate. The owner must surrender the defaced license plate to a local county tax collector's office or license plate agency (along with a copy of the citation) to obtain a replacement at no fee. Lost (not stolen): Replacement fees are required. NOTE: A lost personalized license plate may be issued with the same characters. Lost in Transit: License plates, decals or parking permits lost in the mail may be replaced at no fee, if the application is made within 180 days from the date of issuance. Stolen (not lost): The customer must provide a police report or agency card containing the case number. The replacement will be issued at no charge. If customer does not provide police report or agency card, fees are due.

NOTE: A personalized replacement license plate may be issued with the same characters if the law enforcement agency provides the customer with a statement that such license plate has been removed from the FCIC and NCIC computer files.

Seized: Replacement fees are required.

Surrendered: Replacement fees are required for surrendered license plates. Visit the following website for addresses: https://www.flhsmv.gov/locations/ HSMV 83146 (Rev. 3/19)

Authorization / Release Affidavit

_____________________________________ ______________________________ Name of Registered Owner (s) Title Number _____________________________________ ____________ ____________ Address Year Make __________________ _____ ________ ______________________________ City State Zip Vehicle Identification Number _____________________________________ Phone Number – Including area code I, _____________________________ authorize ____________________________________ (Owner’s Name) (Person Appointed) to receive my title certificate or registration for the above described vehicle. Under penalty of perjury I declare that I have read the foregoing document and certify that the statement is true. ____________________________________ _____________________________ Signature of Owner Date ____________________________________ Signature of Co-Owner

Rev. 6/30/20

Rev. 9/14/20

EFS Dealer Inventory Request DATE: _______________________ DEALER: __________________________ LICENSE# ____________________ BLANK DECALS: QTY: _______ ST. LUCIE COUNTY TAGS (RGR) QTY: _______ SUNSHINE STATE TAGS (RGS) QTY: _______ FORMS: __________________________ __________________________ __________________________ __________________________ COMPLETED BY: _________________________ DATE: _____________ (Signature)

RECEIVED BY: ____________________________ DATE: _____________ (Signature) NOTE: PLEASE VERIFY, SIGN AND EMAIL COPY OF FORM WITHIN 48 HOURS TO: dealerinfo@tcslc.com

This form is available at www.tcslc.com

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

APPLICATION BY FLORIDA MOTOR VEHICLE, MOTORCYCLE, MOBILE HOME OR RECREATIONAL VEHICLE DEALER FOR TEMPORARY LICENSE PLATES

APPLICATION IS HEREBY MADE BY A FLORIDA MOTOR VEHICLE, MOTORCYCLE, MOBILE HOME OR RECREATIONAL VEHICLE DEALER, (WHOSE NAME AND DEALER LICENSE NUMBER APPEARS BELOW)

FOR __________________________ TEMPORARY LICENSE PLATES, AS PROVIDED IN SECTION 320.131, F. S. (Number of plates being requested)

TYPE OF TEMPORARY PLATES REQUESTED: (regular) (motorcycle)

REASON FOR REQUEST: (Trailers under 2,000 lbs.) (ETR Outages) INCLUDED IS THE REQUIRED FEE OF: $ _______________ NAME OF THE DEALER’S ETR/EFS VENDOR: __________________________________________________ (The vendor’s name is required. Otherwise, provide an *explanation of why a vendor is not applicable.)

(*EXPLANATION): _______________________________________________________________________

____________________________________________________________________________ NAME OF THE DEALERSHIP: _______________________________________________________________ ________________________________________________________________________________________ Dealer’s Address ________________________________________________________________________________________ City State Zip Dealer’s License Number: ____________________ UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

SIGNATURE: ______________________________________________ DATE: ____________________ (Authorized Representative for Dealership) NOTE: This form is to be accurately completed by the Florida motor vehicle, motorcycle, mobile home or recreational vehicle

dealer. The original form will be retained by the authorized issuing agency (DMS Regional Office or County License Plate Agency) for a minimum of one year and a copy of this form will be returned to the dealership along with the temporary license plates and the blank HSMV 83091 forms.

FOR AUTHORIZED ISSUING AGENCY ONLY (DMS Regional Office or County License Plate Agency)

NUMBER OF TEMPORARY LICENSE PLATES ASSIGNED: ___________________________________________________________________

ASSIGNED NUMBERS: FROM: ____________________________________ TO: _____________________________________________________

DATE LICENSE PLATES ASSIGNED: _______________ ASSIGNED BY: _________________________________________________________

HSMV 83090 (Rev.07/13) www.flhsmv.gov

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

OFF-LINE ISSUANCE OF A PRE-PRINTED TEMPORARY LICENSE PLATE

Section 320.131(9) (b), Florida Statutes, allows for the issuance of a pre-printed temporary license plate. Pre-printed temporary license plates may only be used by an Electronic Temporary Registration (ETR) participating dealer during a system outage which prevents ETR issuance or by an issuing entity for a trailer weighing less than 2,000 pounds.

This is to certify that temporary license plate number __________________________was issued on _____________ to __________________________________________________________ (Date) (Purchaser’s Name) (Purchaser’s Date of Birth) ____________________________________________________________________________ (Purchaser’s Address) ____________________________________________________________________________________________ (Purchaser’s Driver License Number) The reason for the off-line issuance is _______________________________________________ ______________________________________________________________________________

Vehicle Identification Number Year Make/Manufacturer Body Type Weight of Trailer

Title Number Color Cubic Centimeters (Motorcycles Only)

This is to certify that the above license plate was issued during a system outage or was issued for a trailer weighing less than 2,000 pounds. I understand that the issuance of this temporary license plate must be reported to the department within one business day of the issuance of the plate. _____________________________________________________________________________

(Dealership/Issuing Entity’s Name) _____________________________________________________________________________

(If applicable, current Dealer License Number, including suffix, if additional location)

_____________________________________________________________________________ (Printed Name of Dealer/Issuing Entity’s Authorized Representative)

_____________________________________________________________________________

(Signature of Dealer/Issuing Entity’s Authorized Representative) DEALER: This completed form must be retained in your files for 5 years. A copy must be

retained in the deal jacket. ISSUING ENTITY: This completed form must be submitted to a tax collector’s office or license

plate agency within one business day of the issuance of the plate. A copy of this form should be retained for your records.

HSMV 82082 (Rev. 08/20)

STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTOR VEHICLES

Neil Kirkman Building, 2900 Apalachee Parkway, Tallahassee, FL 32399-0620

REASSI GN M EN T SU PPLEM EN T TO A CERTI FI CATE O F TI TLE NOTICE: (A) THIS FORM IS A SUPPLEMENT FORM WHICH MAY BE USED BY LICENSED MOTOR VEHICLE/VESSEL DEALERS UPON DEALER TRANSFERS. THIS FORM IS TO BE USED ONLY FOR ODOMETER EXEMPT VEHICLES. TO BE USED IN ORDER FROM TOP TO BOTTOM. (B) INDIVIDUALS OR NON-LICENSED DEALERS CANNOT USE THIS FORM OR REASSIGN A CERTIFICATE OF TITLE. (C) EACH REASSIGNMENT SHALL BE IN SUCCESSIVE ORDER AND IS NOT VALID UNTIL COMPLETED IN FULL. (D) ANY ALTERATION OR ERASURE VOIDS THE ASSIGNMENT. (E) SECTION 319.33, FLORIDA STATUTES, PROVIDES: ANY PERSON IS GUILTY OF A FELONY WHO ALTERS OR FORGES ANY ASSIGNMENT OF CERTIFICATE OF TITLE OR RETAINS FOR USE SUCH ASSIGNMENT THAT HAS BEEN ALTERED OR FORGED, ON A CERTIFICATE OF TITLE OR ON A FORM THE DEPARTMENT PRESCRIBES. (F) THE NAME OF DEALER MUST BE LISTED AS IT APPEARS ON DEALER LICENSE. (G) SALES TAX AMOUNT AND SALES TAX NUMBER DO NOT NEED TO BE COMPLETED ON DEALER TO DEALER SALES. (H) AUCTION MUST COMPLETE A REASSIGNMENT AS A LICENSED DEALER.

REASSIGNMENT SUPPLEMENT TO: (CHECK ONE AND PROVIDE TITLE NUMBER) FLORIDA CERTIFICATE OF TITLE NUMBER _______________________ (FOREIGN STATE) CERTIFICATE OF TITLE NUMBER MANUFACTURER'S STATEMENT OF ORIGIN OR CERTIFICATE OF ORIGIN MAKE_______ TYPE_______ YEAR

IDENTIFICATION NUMBER ____________________________________ TRAILER WEIGHT

REASSIGNMENT OF TITLE BY A LICENSED MOTOR VEHICLE DEALER: (COMPLETE IN FULL) FOR VALUE RECEIVED, I, THE UNDERSIGNED LICENSED DEALER, HEREBY ASSIGN AND WARRANT TITLE OF THE MOTOR VEHICLE DESCRIBED IN THE

CERTIFICATE OF TITLE NAMED ABOVE AND CERTIFY THIS SALE AS SPECIFIED BELOW:

PURCHASER(S) DATE OF BIRTH DRIVER LICENSE #

PURCHASER'S RESIDENCE ADDRESS

CO-PURCHASER(S) DATE OF BIRTH DRIVER LICENSE #

CO-PURCHASER'S RESIDENCE ADDRESS

DEALER LICENSE # STATE DEALER IS LICENSED ODOMETER READING DATE READ

I CERTIFY THAT THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, UPON MOTOR VEHICLES HAS BEEN PAID BY THE PURCHASER ON THE ABOVE DESCRIBED VEHICLE. AMOUNT OF SALES TAX COLLECTED FLORIDA SALES TAX REGISTRATION NO.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. NAME OF DEALERSHIP SIGNATURE OF DEALER OR AUTHORIZED REPRESENTATIVE

ADDRESS OF DEALERSHIP DATE

REASSIGNMENT OF TITLE BY A LICENSED MOTOR VEHICLE DEALER: (COMPLETE IN FULL) FOR VALUE RECEIVED, I, THE UNDERSIGNED LICENSED DEALER, HEREBY ASSIGN AND WARRANT TITLE OF THE MOTOR VEHICLE DESCRIBED IN THE

CERTIFICATE OF TITLE NAMED ABOVE AND CERTIFY THIS SALE AS SPECIFIED BELOW:

PURCHASER(S) DATE OF BIRTH DRIVER LICENSE #

PURCHASER'S RESIDENCE ADDRESS

CO-PURCHASER(S) DATE OF BIRTH DRIVER LICENSE #

CO-PURCHASER'S RESIDENCE ADDRESS

DEALER LICENSE # STATE DEALER IS LICENSED ODOMETER READING DATE READ

I CERTIFY THAT THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, UPON MOTOR VEHICLES HAS BEEN PAID BY THE PURCHASER ON THE ABOVE DESCRIBED VEHICLE. AMOUNT OF SALES TAX COLLECTED FLORIDA SALES TAX REGISTRATION NO.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

NAME OF DEALERSHIP SIGNATURE OF DEALER OR AUTHORIZED REPRESENTATIVE

ADDRESS OF DEALERSHIP DATE

THIS FORM IS NOT VALID UNLESS ATTACHED TO THE TITLE THAT IT SUPPLEMENTS (ORIGINAL ONLY). COPIES ARE NOT ACCEPTABLE.

NOTE: A PENALTY FEE IS REQUIRED BY LAW IF NOT SUBMITTED FOR TRANSFER WITHIN 30 DAYS AFTER DATE OF DELIVERY BY DEALER TO RETAIL CUSTOMER.

HSMV 82091 (REV. 8/09) www.flhsmv.gov

Tax Information Publication

TIP

No: 19A01-05 Date Issued: June 5, 2019

Changes to the Hope Scholarship Program Contribution Election Form DR-HS1

The Hope Scholarship Program provides a public-school student, who was subjected to an incident of violence or bullying at school, the opportunity to apply for a scholarship to attend an eligible private school rather than remain in an unsafe school environment.

Changes to Form DR-HS1

Changes have been made to the Hope Scholarship Program to allow excess funding to be used for Florida Tax Credit Scholarships under section 1002.395, Florida Statutes. As a result, the Department of Revenue has included a statement about the Florida Tax Credit Scholarship Program on Form DR-HS1.

All eligible contributions will be used to fund Hope Scholarships. However, if eligible nonprofit scholarship-funding organizations (SFOs) have unused funds at the end of each state fiscal year (June 30), the SFO may carryforward 5 percent of net eligible contributions to fund Hope Scholarships for the next fiscal year. Net eligible contributions in excess of 5 percent will be transferred to other eligible SFOs. If no other SFO participates in the Hope Scholarship Program, net eligible contributions in excess of 5 percent may be used to fund scholarships under the Florida Tax Credit Scholarship Program.

References: Section 9, Chapter 2019-23, Laws of Florida; Section 1002.40, Florida Statutes; Emergency Rule 12AER19-01

For More Information

This document is intended to alert you to the requirements contained in Florida laws and administrative rules. It does not by its own effect create rights or require compliance.

For forms and other information, visit the Department’s website at floridarevenue.com or call Taxpayer Services at 850-488-6800, Monday through Friday (excluding holidays).

For a detailed written response to your questions, write the Florida Department of Revenue, Taxpayer Services MS 3-2000, 5050 West Tennessee Street, Tallahassee, FL 32399-0112.

Want the latest tax information?

✓ Subscribe to our tax publications or sign up for due date reminders at floridarevenue.com/dor/subscribe

✓ Visit the Taxpayer Education webpage at floridarevenue.com for news about live and recorded tax webinars

✓ Follow us on Twitter @FloridaRevenue

DR-HS1R. 05/19

Rule 12AER19-01, F.A.C.Effective 05/19

Page 1 of 1

Hope Scholarship ProgramContribution Election

Eligible Nonprofit Scholarship-Funding Organization:

Step Up for Students, Inc.

Contribution Amount (Lesser of $105, orstate sales tax due):

Vehicle Owner's Name:

Mailing Address:

City: State: ZIP:

Vehicle Co-Owner's Name:

Mailing Address:

City: State: ZIP:

Vehicle Year: Vehicle Manufacturer: Vehicle Identification Number:

Signature of Owner: Date:

Signature of Co-Owner*: Date:

The Hope Scholarship Program (Program) provides a public-school student who was subjected to an incident of violence or bullying at school the opportunity to apply for a scholarship to attend an eligible private school rather than remain in an unsafe school environment. When you purchase or register a motor vehicle qualifying for the Program in Florida, you may designate $105 per vehicle to an eligible nonprofit scholarship-funding organization participating in the Program. If the state sales tax due is less than $105, you may designate the amount of state sales tax due. Your motor vehicle dealer, county tax collector, or private tag agent will remit your contribution to the organization and remit the remaining state sales tax and surtax to the Florida Department of Revenue.Eligible contributions are used to fund scholarships for the Hope Scholarship Program. Contributions may also be used to fund scholarships for the Florida Tax Credit Scholarship Program, which provides a low-income student the opportunity to apply for a scholarship to attend an eligible private school. 

To make your contribution to the Program, complete the following. Sign and date.

* For vehicles owned by more than one person, the signature of the owner and the co-owner is required.

For use by motor vehicle dealer, county tax collector, or private tag agency.

www.flhsmv.gov 1

HSMV 83140 (Rev. 05/19) S

S T A T E O F F L O R I D A

D EPAR T M EN T O F H I G H W AY SAF ET Y AN D M O T O R VEH I C L ES - D IV IS IO N O F M O T O R IS T S E R V IC E S

SUBMIT TITLE AND REGISTRATION FORMS TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

L i cen se Pl ate R at e Cha r t *** REFER TO ADDITIONAL FEE EXPLANATION (Page 2)

TITLE REQUIRED

TAX CLASS CLASSIFICATION NET WEIGHT

IN POUNDS ANNUAL TAX

AND OTHER FEES * Yes 01 Automobiles, private use Thru 2499 $ 27.60 The Yes 01 Automobiles, private use 2500-3499 35.60 registration Yes 01 Automobiles, private use 3500 Up 45.60 taxes Yes 31 Trucks, private and commercial use Thru 1999 27.60 in this Yes 31 Trucks, private and commercial use 2000-3000 35.60 section Yes 31 Trucks, private and commercial use 3001-5000 45.60 are not Yes 42 Chassis Mount Camper, unit affixed to truck chassis Thru 4499 38.60 prorated. Yes 42 Chassis Mount Camper, unit affixed to truck chassis 4500 Up 58.85 Yes 42 Motor Home, living unit self-propelled Thru 4499 38.60 The full Yes 42 Motor Home, living unit self-propelled 4500 Up 58.85 amount will Yes 42 Private Motor Coach Thru 4499 38.60 be charged Yes 42 Private Motor Coach 4500 Up 58.85 regardless * * 52 Trailers, private use Thru 500 18.35 of when

Yes 56 Trailers, drawn by "GVW" series truck-tractors 25.10 during the Yes 62 Camp Trailers, constructed with folding walls 25.10 registration No 70 Transporter 112.85 period the Yes 77 Travel Trailer, up to 35 ft. 38.60 vehicle is Yes 96 Boy Scouts, Churches, etc. 15.60 registered. Yes 97 Exempt Government License Plates 9.80 Yes 103 Permanent Semi-Trailer 101.80 Flat Rate

TITLE REQUIRED

TAX CLASS CLASSIFICATION

LENGTH IN FEET

ANNUAL TAX AND

OTHER FEES*

HALF YEAR TAX AND

OTHER FEES*

QUARTER YEAR TAX AND

OTHER FEES * Yes 51 Mobile Homes Up to 35 25.10 15.10 10.10 Yes 51 Mobile Homes 36 thru 40 30.10 17.60 11.35 Yes 51 Mobile Homes 41 thru 45 35.10 20.10 12.60 Yes 51 Mobile Homes 46 thru 50 40.10 22.60 13.85 Yes 51 Mobile Homes 51 thru 55 45.10 25.10 15.10 Yes 51 Mobile Homes 56 thru 60 50.10 27.60 16.35 Yes 51 Mobile Homes 61 thru 65 55.10 30.10 17.60 Yes 51 Mobile Homes 66 & Up 85.10 45.10 25.10 No 65 Motorized and Disability Access Vehicles 24.10 17.35 15.60

Yes 65 Motorcycles 24.10 17.35 15.60 No 69 Mopeds, pedal activated (motor NOT in excess of 2 BHP) 19.10 17.35 17.35

No 71 Dealer’s License Plates – Franchised, Independent, Trailer Coach, Motorcycle, or Marine Boat Trailer 55.60 27.80 13.90

Yes 76 Park Trailers, regardless of length 36.60 24.10 17.85 Yes 78 Travel Trailers Over 35 36.60 24.10 17.85 Yes 80 Antiques - Motorcycle 21.60 14.85 13.10 Yes 92 School Buses (privately owned) and Regular Wreckers 52.60 32.10 21.85 Yes 92 Hearses and Ambulances 52.10 31.85 21.73

Yes 94

Tractor Cranes, Power Shovels, Well Drillers and other such vehicles, so constructed and designed as a tool and not a hauling unit, used on the roads and highways incidental to the purpose for which designed.

55.60 33.60 22.61

Yes 95 Antiques - Passenger Cars 20.60 15.48 15.35

www.flhsmv.gov 2

HSMV 83140 (Rev. 05/19) S

License Plate Rate Chart (continued) These categories are computed based on CWT (per each 100 pounds) and may be purchased for 12, 6, or 3 months. Add the flat tax plus $1.50 per each 100 pounds to determine the annual tax amount. Then compute one-half or one-quarter of the Annual Tax, if applicable. Add service and other fees.

TITLE REQUIRED

TAX CLASS CLASSIFICATION WEIGHT ANNUAL TAX

FLAT (per cwt) SERVICE AND OTHER FEES *

** 54 Trailers, "For Hire" Thru 1999 lbs. $ 3.50 + 1.50 + 11.60 Yes 54 Trailers, "For Hire" 2000 lbs. & up 13.50 + 1.50 + 11.60 Yes 09 Automobiles "For Hire" Passengers up to 8 17.00 + 1.50 + 11.60

TITLE REQUIRED

TAX CLASS CLASSIFICATION MONTHLY PRORATION OF TAX

GVW 12 11 10 9 8 7 6 5 4 3 2 1 Yes 39 Forestry Trk-Trac 359.15 332.15 305.15 278.15 251.15 224.15 197.15 170.15 143.15 116.15 89.15 62.15

Yes 41 Trk-Trac 5001-5999 72.35 67.29 62.23 57.16 52.10 47.04 41.98 36.91 31.85 26.79 21.73 16.66

Yes 41 Trk-Trac 6000-7999 99.35 92.03 84.73 77.41 70.10 62.79 55.48 48.16 40.85 33.54 26.22 18.92

Yes 41 Trk-Trac 8000-9999 114.60 106.02 97.43 88.85 80.27 71.68 63.10 54.52 45.93 37.35 28.77 20.18

Yes 41 Trk-Trac 10000-14999 139.60 129.77 119.93 110.10 100.27 90.43 80.60 70.77 60.93 51.10 41.27 31.43

Yes 41 Trk-Trac 15000-19999 198.60 183.85 169.10 154.35 139.60 124.85 110.10 95.35 80.60 65.85 51.10 36.35

Yes 41 Trk-Trac 20000-26000 272.60 251.68 230.77 209.85 188.93 168.02 147.10 126.18 105.27 84.35 63.43 42.52

Yes 41 Trk-Trac 26001-34999 345.60 318.60 291.60 264.60 237.60 210.60 183.60 156.60 129.60 102.60 75.60 48.60

Yes 41 Trk-Trac 35000-43999 426.60 392.85 359.10 325.35 291.60 257.85 224.10 190.35 156.60 122.85 89.10 55.35

Yes 41 * Trk-Trac44000-54999 794.60 730.18 665.77 601.35 536.93 472.52 408.10 343.68 279.27 214.85 150.43 86.02

Yes 41 * Trk-Trac55000-61999 937.60 861.27 784.93 708.60 632.27 555.93 479.60 403.27 326.93 250.60 174.27 97.93

* For GVW Wreckers 44,000-55,000 lbs., reduce the fee by $1.00. * For GVW wreckers 55,000-62,000 lbs., reduce the fee by $1.00.

Yes 41 Trk-Trac 62000-71999

1101.60 1011.60 921.60 831.60 741.60 651.60 561.60 471.60 381.60 291.60 201.60 111.60

Yes 41 Trk-Trac 72000-80000

1343.60 1233.44 1123.26 1013.10 902.94 792.76 682.60 572.44 462.26 352.10 241.94 131.76

Yes 91 Antique Trk - 5000 lbs. Net Wt. 20.60 19.98 19.35 18.73 18.10 17.48 16.85 16.76 16.76 16.76 16.76 16.76

Yes 93 Goats 19.10 18.48 17.85 17.23 16.60 15.98 15.35 15.26 15.26 15.26 15.26 15.26

Yes 102 Agri, Trk, Trac thru 43999 109.35 102.03 94.73 87.41 80.10 72.79 65.48 58.16 50.85 43.54 36.22 28.92

Yes 102 Agri, Trk, Trac 44000 – 80000 345.60 318.60 291.60 264.60 237.60 210.60 181.60 156.60 129.60 102.60 75.60 48.60

The categories below are computed based on CWT (per each 100 pounds) and may be monthly prorated. Add the flat fee plus the $1.50 or $2.00 amount, whichever applies, per each 100 pounds to determine the annual tax amount. Divide by 12 months to determine the tax per month. Then compute the tax by multiplying the monthly rate times the number of tax months due and add the service and other fees to determine the total amount.

TITLE REQUIRED

TAX CLASS CLASSIFICATION NET WEIGHT

IN POUNDS ANNUAL TAX

FLAT (per cwt) SERVICE AND OTHER FEES *

** 53 Trailers, Private Use 501 Up $ 3.50 + 1.00 + 11.60

Yes 36 Buses May be registered semi-annually for one-half of registration tax and $2.50 semi-annual fee. Passengers 9 Up 17.00 + 2.00 + 21.60

FEES: * $ .10 Emergency Medical Services $1.00 Air Pollution Control $ 2.80 Advanced Replacement $ 0.50 Reflectorization $1.00 Law Enforcement Radio System $ 2.50 Accident Records $ 0.50 FRVIS $1.50 Transportation Disadvantaged $ 2.50 Service Charge $ 1.00 Juvenile Justice $1.20 Surcharge for State Transportation $10.00 State Transportation $ 1.00 Decal on Demand

** Trailers through 1999 pounds, are NOT titled. *** Add $28.00 when metal license plate is to be issued.

Add $225.00 Initial Registration Fee when applicable. Refer to License Plate Rates Instruction Sheet (page 3) for additional information.

www.flhsmv.gov 3

HSMV 83140 (Rev. 05/19) S

I. REGISTRATION PERIODSLICENSE PLATE RATES INSTRUCTION SHEET

The 12-month registration period begins the first day of the owner's birth month (Exceptions: Company owned vehicles use the month of June; truck-tractors, semi-trailers and buses use a December birth month). Mobile homes use a January 1 begin date. If the rate chart indicates annual, halfyear, and quarter year fee calculations, you must determine the number of months of tax required. To determine the number of months of taxrequired, start with the month the vehicle was purchased or subject to registration and count through the month prior to the owner's birth month.Three months or less requires the quarter year rate, four to six months requires the half-year rate, and over six requires the full year rate. (Example:You purchased your vehicle in November and your birth month is June, count a total of seven months (November through May) and the full year ratewould be required. II. TRUCKS AND TRAILERS – WEIGHTSFor trucks weighing 5,000 lbs. or less, if the shipping weight is not available on the manufacturer's certificate of origin, the net weight or actualscale weight in pounds with complete catalog equipment must be provided. A certified weight affidavit from a weighing station will meet thisrequirement. The gross vehicle weight (GVW) as declared by the owner, is required on all truck-tractors and trucks weighing over 5000 pounds.For heavy trucks with net weight of 5001-7999 lbs., GVW is calculated by adding the net weight of the truck and the truck's load. For heavy truckswith net weight of 8000 lbs. up and truck-tractors, the GVW is calculated by adding the net weight of the truck or truck-tractor and its load to the netweight of the trailer and its load.

III. INITIAL REGISTRATION FEEImposed upon the initial application for registration of private automobiles, trucks 5,000 lbs. or less and motor homes.The $225.00 Initial Registration Fee does not apply to:A. Any registration renewal transaction.B. A transfer or exchange of a registration license plate for a motor vehicle that has been disposed of to a newly acquired motor vehicle in

compliance with Sections 320.0609(2) or (5), Florida Statutes.C. Any initial registration that occurs when a transfer of Florida title is processed between co-owners as provided by Section 319.22, Florida

Statutes, or when a transfer of ownership by operation of law occurs as provided by Section 319.28, Florida Statutes. Additionally, the feedoes not apply when the transfer of title occurs from a person to a member of that person's immediate family. Section 657.002, FloridaStatutes, defines immediate family as parents, children, spouse, or surviving spouse of the member, or any other relative by blood, marriage, oradoption residing in the same household with the registered owner.

D. The registration of a motor vehicle owned by and operated exclusively for the personal use of:1) Any member of the United States Armed Forces, or his/her spouse or dependent child, who is not a resident of this state and who is

stationed in this state while in compliance with military orders.2) Any former member of the United States Armed Forces, or his/her spouse or dependent child, who purchased such motor vehicle while

stationed outside of Florida, who has separated from the Armed forces and was not dishonorably discharged or discharged for badconduct, who was a resident of this state at the time of enlistment and at the time of discharge, and who applies for registration of suchmotor vehicle within 6 months after discharge.

3) Any member of the United States Armed Forces, or his/her spouse or dependent child, who was a resident of this state at the time ofenlistment, who purchased such motor vehicle while stationed outside of Florida, and who is now reassigned by military order to thisstate.

4) Any spouse or dependent child of a member of the United States Armed forces who loses his life while on active duty or who is listed bythe Armed Forces as "missing-in-action." Such spouse or child must be a resident of this state and the serviceman must have been aresident of this state at the time of enlistment. Registration of such motor vehicle must occur within 1 year of the notification of theserviceman's death or of his status as "missing-in-action."

5) Any member of the United States Armed Forces, or his/her spouse or dependent child, who was a resident of this state at the time ofenlistment, who purchased a motor vehicle while stationed outside of Florida, and who continues to be stationed outside of Florida.

E. The registration of any motor vehicle owned or exclusively operated by the state or by any county, municipality, or other governmental entity.F. The registration of a truck defined as a "goat", or any other vehicle when used in the field by a farmer or in the woods for the purpose of

harvesting a crop, including naval stores, during such harvesting operations, and which is not principally operated upon the roads of this state.The "goats" are registered under "class code 93".

G. The registration of an automobile or truck defined as "ancient" (the vehicle was manufactured in 1945 or earlier) or "antique" (the vehicle wasmanufactured beginning 1946 and of the age of 30 years or more after the date of manufacture), pursuant to s. 320.086(1) or (2), FloridaStatutes.

H. The initial registration fee shall not apply to any newly acquired vehicle, upon submission of an affidavit, indicating that the previous vehicle (notdisposed of) is not operational, or is in storage, or will not be operated on the streets and highways of this state.

IV. SALES TAXFlorida law requires sales tax to be collected on the purchase price of a motor vehicle, mobile home, or vessel. In the case of a straight sale, six(6) percent tax will be collected on the total purchase price. Straight sales are those sales that do not involve a trade-in of a motor vehicle, mobilehome, or vessel.In the case of sales involving trade-ins, sales tax must be collected on the amount of the cash difference between the retail value of the trade-in,as covered in any official used motor vehicle, mobile home or vessel guide, and the sale price of the motor vehicle, mobile home, or vesselacquired. The trade-in motor vehicle, mobile home, or vessel may be provided by a third party other than the purchaser. The trade-in motorvehicle, mobile home, or vessel does not have to be titled in the name of the purchaser, to be used for trade-in credit, as long as the motorvehicle, mobile home or vessel trade-in and the motor vehicle, mobile home or vessel purchase are part of a single transaction.In addition to the six (6) percent sales tax, some counties charge a local discretionary sales surtax. Discretionary surtax is calculated on motorvehicles, mobile homes, or vessels when the residence address of the purchaser on the certificate of title or registration is located within adiscretionary surtax county. The discretionary sales surtax applies to the first $5,000 of the sales price. For more information on thediscretionary surtax you may contact the Florida Department of Revenue or your Florida County Tax Collector’s office.Sales tax exemption information may be specified on an accurately completed form HSMV 82040, Application for Certificate of Title with/withoutVehicle Registration.

CALCULATION OF FEES AND CHECK OFF LIST ITEMS TO BE COMPLETED BEFORE SUBMITTING (see Tax Collectors Mailing List) YOUR REQUEST:

1.

Enter the license plate fee from page 1 or 2. NOTE: A biennial registration may be issued by doubling the annual tax. Add both amounts and insert the total in the first space provided. If transferring a valid Florida license plate, see number six (6) below. Add $28.00 when new metal license plate is to be issued. Add $225.00 Initial Registration Fee, if applicable (See page 3, III). Add $.50 branch fee if processing through a county branch office.

$

$ $ $

2.

Title fee (if applicable), enter $75.25 for new vehicles, $85.25 for vehicles previously registered in another state. Titles are not issued on trailers through 1,999 lbs., mopeds, or motorized bicycles.

If processing through a county branch office, add $.50 branch fee.

$

$

3. If recording a lien, enter $2.00. $

4. If over 30 days from date of purchase, enter $20.00 for a motor vehicle, $10.00 for a vessel or off-highway vehicle. $

5. Enter a $2.00 lemon law fee if application is for a new vehicle purchased or leased for one year or longer in Florida and is a passenger car or truck with a gross vehicle weight of 10,000 pounds or less (only applies to Florida Dealers and Leasing Companies). $

6.

If transferring a valid Florida license plate to a replacement vehicle, enter $4.10. If additional transfer fee required, enter $4.50 (any license plate transferred to or from any vehicle other than a passenger automobile or truck under 5,000 lbs. will require a transfer fee in addition to the regular tax and fees indicated above).

$

$

7. Enter mail fee ($4.70 first class metal license plate; or for renewal decal $.75). $

8. If sales tax is due, enter amount (refer to page 3, IV). If requesting a dealer license plate, enter annual use tax of $27.00 per license plate.

$ $

9. If requesting expedited title service: Add $10.00 additional fee per application. $

10.

If you are requesting the actual paper certificate of title to be mailed to you, add $2.50. If you are requesting the title to be held electronically by the department, there is no fee. This information must be specified in section 1 on your accurately completed form HSMV 82040, Application for Certificate of Title With/Without Registration.

$

11. If requesting a Personalized License Plate, enter the additional fee based on license plate type. * See below for more information. $

12. If requesting a Specialty License Plate, enter the additional fee based on license plate type as well as the $5.00 processing fee. ** See below for more information. $

13. Amount due: Enter total of above lines 1-12. $ OWNER'S CHECK OFF LIST (CHECK EACH APPROPRIATE BOX, AFTER COMPLETION:)

14. Enter the total from line 13 on your check/money order, made payable to your County Tax Collector.

15. Proof of insurance enclosed (see attached Florida Insurance Affidavit and Military Insurance Exemption Information).

16. Proof of ownership (documents will be retained by the Department):a.) New Cars: Manufacturer's certificate of origin from all states, except the State of Nevada, which also requires the dealer's

report of sale form.Used Cars: (cars already titled/registered in another state): Certificate of title, if from a title state, or registration or other

b.) official document showing ownership must be submitted, if from a non-title state or foreign country.17. All required application forms must be accurately completed and signed.

Additional fees are due for a personalized or specialty license plate. * For Personalized License Plate fee information, see form HSMV 83043, Application for Personalized License Plate:http://www.flhsmv.gov/dmv/forms/BTR/83043.pdf.** For Specialty License Plate information, visit the following website: http://www.flhsmv.gov/dmv/specialtytags/. YOUR REQUEST WILL BE RETURNED UNPROCESSED, UNLESS YOU HAVE COMPLIED WITH ALL OF THE ABOVE INSTRUCTIONS.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/ HSMV

83140 (Rev. 05/19) S www.flhsmv.gov 4

FLORIDA INSURANCE AFFIDAVIT

Under penalty of perjury, I __________________________________________ certify that I have (Name of Insured)

Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability

Insurance currently in effect with _____________________________________________ under (Name of Insurance Company)

__________________________ ____________________ covering the following motor vehicle: (Policy Number) Company Code Number (5 digits)

_________________________________________________________________________________________________________ Year Make Vehicle Identification Number

This insurance company is licensed to issue insurance policies in Florida. I understand that my driver license, license plate(s) and registration(s) will be suspended effective from the registration date, if the insurer denies that this policy is in force.

_______________________________________ Signature of Insured

WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE REGISTRATION

CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA LAW. ANYONE GIVING FALSE INFORMATION ON THIS AFFIDAVIT IS SUBJECT TO PROSECUTION.

HSMV 83330 (Rev. 09/09) www.flhsmv.gov