Affidavit
The undersigned hereby certifies the following fact(s) regarding vehicle/vessel described:
Make _________Year _______ ID # ____________________________________Title _____________________
1. _______ My name was entered in error as purchaser on the above title. I have never had possession or any
interest in
this vehicle/vessel.
2. _______ The name_______________________________ was entered in error as purchaser. This person never took
possession and vehicle /vessel was resold
to ______________________________ for __________________.
3. _______ My name was entered in error as lien-holder on above title. I do not hold any lien against this vehicle/vessel.
4. _______ The names _____
_________________________________ and ____________________________________
shown on the attached papers identify one and the same person.
5. _______ Military Non-resident, my state of residency is _________________________________________________
6. _______ The above vehicle has not been/will not be operated upon the public highway
s of Florida or has been sold or
disposed of.
7. _______ The above vessel has not been operated upon the public waterways of Florida for 12 or more months.
8. _______ There is an odometer discr
epancy because ____________________________________________________
_______________________________________________________________________________________
9. _______ The identification number t
hat appears on the Florida title is incorrect. I visually inspected the identification
number on the vehicle/vessel and found it to be the following: _____________________________________
10. _______ As owner of the above vehicle, I request the vehicle be classified as a recreational vehicle as the following
has been installed: ( ) 11
0 volt electrical wiring ( ) LP gas piping ( ) Plumbing system
11. _______
I am the lawful owner of the above vehicle; the _________________________ body has been removed and
____________________________ body installed; title is herewith surrendered for correction of vehicle type.
12. _______ After a thorough visual inspection of
the above vessel, I have been unable to locate any existing hull
identification number on the vessel.
13. ________ The license plate __________________ is (check one) ____ Lost ____ Stolen ____ Destroyed. If recovered,
the plate will not be used on any motor vehicle. I understand if I replace the plate I must pay any required
fees (approximately $36.90, if current).
14. _________ Other _________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
Date: _____________________
__________________________________
_
Affiant Signature
____
_______________________________
Affiant Signature
Revision Date 11/15
Printed Name
Printed Name
