MILITARY MEMBERS registering in Florida:

Customer must have a FLORIDA LICENSE

I will need a copy of their MILITARY ORDERS.

I WILL NEED ALL FORMS SIGNED BYMILITARYCUSTOMER, AND THEY MUST BE ORIGINALSIGNATURES, NO SCANNED COPIES, NO STRIKE OVERONVIN #,AND NO WHITE OUT ON THE VIN.

Thank you,Lori Pulley218 Valencia Shores DriveWinter Garden, FL 34787407-877-9349

STATE OF FLORIDADEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICEwww.f1hsmv.gov/offices/

INITIAL REGISTRATION FEE EXEMPTION AFFIDAVITVEHICLE IDENTIFICATION NO. YEAR MAKE BODY PREV.STATE TITLE NO.

PLEASE CHECK THE APPROPRIATE BOX AND SIGN

The applicant claims exemption from the $225.00 Initial Registration Fee, which is imposed on the initial applicationfor registration on a motor vehicle, and attests to one of the following:

D

DD

D

D

D

I am a qualifying member of the u.s. Armed Forces, or his or her spouse or dependent child. I am claimingexemption # (see list on the reverse side of this form in section A, 1-6, which also lists the requireddocuments). Select exemption reason of "military." The customer must complete and sign this form to claim theexemption.

A Court Order declares/specifies that the applicant is the legal owner of the above described motor vehicle. Selectexemption reason of "court order." (A copy of the court order must be submitted.)

A license plate is being transferred (for a name change) due to a fictitious name change affidavit or corporate namechange affidavit properly filed with the Department of State, pursuant to section 865.09, Florida Statutes. Selectexemption reason of "administrative." (A copy of the name change affidavit from the Department of State must besubmitted.)

A transfer of ownership on a Florida Certificate of Title has occurred due to operation oflaw as provided by section319.28, Florida Statutes. Select exemption reason of "operation oflaw." (A copy ofthe documentation whichvalidates how the vehicle was acquired must be submitted.)

A transfer of ownership on a Florida Certificate of Title has occurred from a person to a member of that person'simmediate family as defmed in 657.002, Florida Statutes, who resides in the same household. Select exemptionreason of "immediate family." (NOTE: The address of the previous owner and new owner must be the samein the FRVIS system).

A prior registration or system printout has been submitted for the following license plate number ('-- ),in order to claim the initial registration exemption for the recently acquired above described vehicle. Selectexemption reason of "prior registration. "

AN EXEMPTION REASON MUST BE SELECTED IN THE SYSTEM TO RECORD EXEMPTION.

Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated init are true.

Signature of Owner DatePrinted Name of Owner

NOTE: Owner's signature is only required for the military exemption.

FOR FLORIDA DMS OR TAX COLLECTORILICENSE PLATE AGENCY USE ONLY

DNOTE: Employee must verify (below) all exemptions Oisted above):

The exemption (checked above) has been verified by (County #) (Agency #) _

Signature of Employee DatePrinted Name of Employee

HSMV 82002 (Rev. 01114) www.flhsmv.gov

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t tA. LIST OF QUALIFYING MILITARY EXEMPTIONS:

1. I am a member of the U. S. Armed Forces, or his or her spouse or dependent child, who is not aFlorida resident and is stationed in the state of Florida on military orders. Submit a copy ofyour military orders and out of state driver license.

2. I am a member of the U. S. Armed Forces, or his or her spouse or dependent child, who is/wasnot a Florida resident and is stationed in the state of Florida on military orders and is nowbecoming a resident of Florida. Submit a copy of your military orders and Florida driverlicense.

NOTE: The prior non-resident member or his/her spouse or dependent child wouldqualify for this exemption even if the vehicle were not previously registered inFlorida as a "Registration Only." Some members retain an out of state licenseplate for their vehicle from their state of residence while stationed in Florida.

3. I am a former member of the U.S. Armed Forces, or his or her spouse or dependent child. Ipurchased this motor vehicle while stationed outside Florida. I was not dishonorablydischarged nor discharged for bad conduct. I was a resident of Florida at the time ofenlistment and discharge and continue to be a resident of Florida. I am applying forregistration within 6 months after discharge. Submit a copy of your Discharge Order (DD214)and Florida driver license.

4. I am a member of the U.S. Armed Forces, or his or her spouse or dependent child, who was aresident of Florida at the time of enlistment and continue to be a resident of Florida. Ipurchased a motor vehicle while stationed outside of Florida. I have been reassigned bymilitary orders to this state. Submit a copy of your military orders and Florida driver license.

5. I am a member of the U.S. Armed Forces, or his or her spouse or dependent child, who was aresident of Florida at the time of enlistment and continue to be a resident of Florida. Ipurchased a motor vehicle while stationed outside of Florida, and continue to be stationedoutside of Florida. Submit a copy of your military orders and Florida driver license.

6. I am a resident of Florida and a spouse or dependent child of a member of the U.S. ArmedForces, who lost his/her life (submit proof of military death notification) or is listed as"Missing in Action" (MIA) (submit proof of MIA status).

NOTE: The member ofthe armed forces must have been a resident of Florida at the time ofenlistment. Registration must occur within one (1) year of notification of death or MIAstatus.

B. TillS FORM SHOULD NOT BE USED WHEN:

1. The U.S. armed forces member is not a resident of Florida AND is not assigned by militaryorders to the state of Florida.

2. The U.S. armed forces member is dishonorably discharged or discharged for bad conduct.

Check your local phone book government pages or visit the following website for current

mailing addresses: http://www.f1hsmv.gov/offices/

HSMV 82002 (Rev. 01114) www.flhsmv.gov

Certificate of Entitlement for U.S. Military Service Personnel (Currently Stationed in aState Other Than Florida) Claiming an Exemption from Florida Sales Tax

I --------;::-:------;:-::--:-::c:-----:----,-------- , am a military member who has purchased the(Name of Military member)

motor vehicle/vessel listed below in while stationed outside ofFlorida: -----------

(State)

(Year) (Make ofVehicleNessel) (Vehicle/Vessel identification Number)

I am certifying the following:

• I am a resident of the state of Florida.

• I am currently residing outside of Florida pursuant to military orders.

• The vehicle/vessel will be held outside of Florida for longer than 6 months.

• I will not bring the vehicle/vessel into the state of Florida within 6 months from the date ofpurchase, even for temporary reasons.

• I recognize that I owe tax to the state in which the motor vehicle was purchased, unless aspecific exemption applies.

• I do not intend to avoid sales or use tax in any state by registering the vehicle/vessel inFlorida.

I understand that if I fraudulently issue this certificate to evade the payment of sales tax I willbe liable for payment of the sales tax plus a penalty of200% of the tax and may be subject toconviction of a third degree felony.

Under the penalties of perjury, I declare that I have read the foregoing Certificate ofEntitlement and the facts stated in it are true.

(Date)x

(Signature of Military Member)

Certificate for Florida Resident Who is an Active Duty U.S. Military MemberCurrently Stationed in a State Other Than Florida

AFFIDAVIT

I ::-:-_~-:-__=_-:_=:__------, am an active duty military member who maintains the(Name of Active Duty Military member)

motor vehicle/vessel listed below while stationed outside of Florida:

(Year) (Make of Vehicle/V esseJ) (VehicleNesseJ identification Number)

Iam certifying the following:

• The active duty military member is a Florida resident who claims Florida as his/her home ofrecord.

• The active duty military member is currently residing outside of Florida pursuant to militaryorders

effective I am stationed in(Date) (State)

• The active duty military member has an out of state mailing address.

• The active duty military member's vehicle is being maintained in the member's state ofmilitary assignment and will not be driven in the state of Florida. except in a transient visitorstatus.

• The active duty military member is providing acceptable out of state proof of insurance forthe vehicle shown above.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THIS DOCUMENT ANDTHE FACTS STATED IN IT ARE TRUE.

(Signature of Military Member or Spouse)

THIS EXEMPTION ONLY APPLIES TO VEHICLES REGISTERED IN THE NAME OF THEMILITARY MEMBER, OR THEIR NON-MILITARY SPOUSE OR DEPENDENTCHILD/CHILDREN.

MILITARY INSURANCE EXEMPTION INFORMATION

The exemption for providing proof of Florida insurance applies in the followingcircumstances:

1. The military member or non-militaryspouse is an owner, co-owner or registrant.

and

2. The military member is a Florida resident stationed outside Florida.

All of the following are required:

1. An out-of-state mailing address (which will be shown on the Florida VehicleRegistration Certificate) for the military member.

2. !h A copy of the military orders for all original relzistrations. This is alsoacceptable proof for renewals.

or

b. For renewals, the military member's military ID. If an ID is presented asproof of military assignment, it must not contain the word "retired". Retiredmilitary members living in Florida are considered Florida residents and assuch must comply with Florida insurance requirements and have a Floridadriver license.

or

c. An affidavit from the military member confirming the member's militaryassignment to another state and the date of assignment. (See Exhibit F).and

3. An affidavit stating the vehicle is being maintained in the member's state ofmilitary assignment and will not be driven in the state of Florida, except in atransient visitor status (See Exhibit F).

4. Proof of insurance as described in Verification: A. Acceptable Forms ofProof on pages three and four of this procedure. If proof of insurance issubmitted in a language other than English, it must be accompanied by a writtentranslation into the English language.

MILITARY INSURANCE EXEMPTION INFORMATION

The exemption for providing proof of Florida insurance applies in the following circumstances:

1. The military member or spouse is an owner, co-owner, or registrant.

or2. The military member is a Florida resident stationed outside Florida.

All of the following is required:

1. An out4-slate mailing address (which will be shown on the Florida Vehicle RegistrationCertificate) for the military member./ 0:.copy of the military orders

An affidavit from the military member's commanding officer that confirms the member'smilitary orders and the date of assignment.

3. An affidavit stating the vehicle is being maintained in the member's state of military assignmentand will not be driven in the state of Florida, except in a transient visitor status (see sampleaffidavit below).

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l)'.4. A letter on letterhead stationery from the out-of-state insurance company/agent stating that themilitary member is currentl insured in the state where he/she is activel stationed.

is letter should contain all policy information including name of insured, effective date ofinsurance, insurance company name, policy number, and vehicles covered. (A faxed letter onletterhead stationery is permissible).

If proof of insurance is in a language other than English, it must be accompanied by a writtentranslation into the English language.

AFFIDAVIT

____ =-=-_--=-:-= -:-- ----:----certify that my vehicle is maintained in the(Name of Military Member or Spouse)

state of , where I am on military orders and will not be driven in the state of---------Florida, except in a transient visitor status.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ TIllS DOCUMENT ANDTHE FACTS STATED IN IT ARE TRUE.

(Signature of Military Member or Spouse)

THIS EXEMPTION ONLY APPLIES TO VEmCLES REGISTERED IN THE NAME OF THE MILITARYMEMBER OR THE NON-MILITARY SPOUSE.

STATE OF FLORIDADivision 0 Motorist Services

PROCEDURE # SUBJECT:

RS-36 INSURANCE VERIFICATION

IV. ADDITIONAL INFORMATION:

A. If the vehicle is in the name of an individual whose driver license has been suspended fornot having insurance, unpaid tickets or delinquent support, another individual cannotpurchase insurance for that vehicle unless the title is transferred and a new license platepurchased.

B. When a vehicle is registered in a child's name, insurance can be purchased in the parents'name as long as they reside in the same household. However, when the owner of thevehicle and the person who purchases insurance coverage are different, the owner of thevehicle is ultimately responsible for insurance coverage.

C. Insurance companies report the issuance of policies by VIN and DL number. This tiestogether the insurance, driver license and vehicle registration files.

D. Nonresident military personnel stationed in Florida, who register their vehicles inFlorida, must have Florida insurance.

E. A Florida resident or their spouse on military assignment outside of Florida is notrequired to submit proof of Florida insurance coverage. The military member mustprovide the following:

l. An out-of-state mailing address, (which will be shown on the Florida VehicleRegistration Certificate) for the military member.

2. The military member's Florida address of residence, which will be shown in theDMS database.

3. One of the following must be submitted as proof of current military assignmentout-of-state:a. A copy of the military orders.

orb. An affidavit from the military member's commanding officer that

confirms the member's military orders and the date of assignment.4. An affidavit stating the motor vehicle is being maintained in the member's state of

military assignment and will not be driven in the state of Florida, except in atransient visitor status. Refer to Exhibit E.

5. A letter on letterhead stationery from the out-of-state insurance company/agent stating that the military member is currently insured in the state wherehe/she is actively stationed. This letter should contain all policy informationincluding name of insured, effective date of insurance, insurance companyname, policy number, and vehicles covered. (A faxed letter on letterheadstationery is permissible).

I'AGE#

RS-36-06

9800 Fredericksburg RoadSan Antonio, TX 78288

JEANNETTE VENIETA -SSGT USAF300 MASS AVE NW APT 327WASHINGTON DC 20001-2745GIC 021154550 7103

January 4, 2017

Action Needed: Confirmation of Insurance

Dear Sergeant Esson,

This letter is to inform whom it may concern, that Sergeant Esson's 2017 MERCEDES CLACLASS VIN: WDDSJ4GB3HN399074 is currently insured in the state of District of Columbia underpolicy 021154550 with effective dates of 12/15/2016 to 6/15/2017. The coverage limits are asfollows, bodily injury liability is 25,000/50,000 with 25,000 in property damage liability. SergeantEsson also currently has comprehensive and collision deductibles of 1000.00.

We value your business and look forward to serving all your financial needs.

Sincerely,

Cherie G McdermottPolicy ServiceUSM General Indemnity Company

021154550 - DM-04664 55557-0616

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