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
Iiiiiii
OR AND NOTE: When joint ownership, please indicate if “or” or “and” is to be shown on title when issued. If neither box is checked, the title will be issued with "and."
If applicable: Life Estate/Remainder Person Tenancy By the Entirety With Rights of Survivorship Owner's County of Residence: _____________________________________
ppears 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 DIGIT ODOMETER NOW READS , .XX (NO TENTHS) 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
www.flhsmv.gov
HSMV 82040 REV. 11/15 RULE
15C-21.001, FAC
8
MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATION
T
HIS 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
S
TATIONERY. 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
T
ITLED IN FLORIDA.
I, the 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___________________________
C
OMMISSIONED NAME OF FLORIDA NOTARY: __________________________________________________ NOTARY'S SIGNATURE _________________________________________________
(Print, Type or Stamp)
9
SALES TAX EXEMPTION CERTIFICATION
T
HE 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:
PURCHASER (STATE AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE
CONSUMER’S CERTIFICATE OF EXEMPTION NUMBER
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)
1
0
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
A
PPLICATION 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 FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
_________________________________________________________________________________________________ _________________________________________________________________________________________________
SIGNATURE OF APPLICANT (OWNER) Date SIGNATURE OF APPLICANT (CO-OWNER) Date
1
3
RELEASE OF SPOUSE OR HEIRS INTEREST
The undersigned person(s) state(s) as follows:
That _________________________________________________________________________ died on _____________________________.
(Name of Deceased) (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:
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
Name of Applicant(s) (Print or Type)
RULE 15C-21.001, FAC
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