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/
Notice of Sale and/or Bill of Sale for a Motor Vehicle,
Mobile Home, Off-Highway Vehicle or Vessel
Notice of Sale (Seller must complete sections 1 & 3). The purchaser’s signature in section 3 is optional.
Bill of Sale (Seller and purchaser must complete sections 1, 2 (when applicable) & 3).
1. Motor Vehicle, Mobile Home, Off- Highway or Vessel Description
Year
Make/Manufacturer
Body Type
Model
Color
Certificate of Title Number Vehicle/Vessel Identification Number
I/we do hereby sell or have sold and delivered the above described motor vehicle, mobile home,
off-highway vehicle or vessel to:
Print Name(s) of Purchaser(s)
Address City State Zip Code
Date of Sale
Selling price
$
2. Odometer Disclosure Statement (Required For a Motor Vehicle)
Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure to
complete or providing a false statement may result in fines and/or imprisonment.
WE STATE THAT THIS MOTOR VEHICLE’S 5 DIGIT 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 THE ACTUAL MILEAGE. 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3. IS NOT THE ACTUAL MILEAGE.
Affidavit (When applicable):
3.
Certification
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 Sell
er's Printed Name Date
Seller's Address City State Zip Code
Co-Seller's Signature (when applicable) Co-Seller's Printed Name (when applicable) Date
Co-Seller's Address (when applicable) City State Zip Code
Purchaser's Signature Purchaser's P
rinted Name Date
Co-Purchaser's Signature (when applicable) Co-Purchaser's
Printed name (when applicable) Date
OWNERSHIP STATUS FOR THE ABOVE DESCRIBED MOTOR VEHICLE, MOBILE HOME, OFF-HIGHWAY VEHICLE OR VESSEL
WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE.
Check your local phone book government pages or visit the following website for current mailing
addresses: www.flhsmv.gov/offices/
HSMV 82050 (Rev. 06/11) S
Made Fillable by FreeForms.com
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome