Fillable Plate Surrender Missing PBCTC Form 138 11 8-2016 (Constitutional Tax Collector)

Fill Online, Printable, Fillable, Blank Plate Surrender Missing PBCTC Form 138 11 8-2016 (Constitutional Tax Collector) Form

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Plate Surrender Missing PBCTC Form 138 11 8-2016 (Constitutional Tax Collector)

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The Plate Surrender Missing PBCTC Form 138 11 8-2016 (Constitutional Tax Collector) form is 1 page long and contains:

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Country of origin: US
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Affidavit
The undersigned hereby certifies the following fact(s) regarding the vehicle/vessel described:
Vehicle/Vessel Identification Number
Year
Make
Color
Body
Title Number
The above vehicle has not been/will not be operated upon the public highways of Florida.
The above vehicle was continuously maintained in dead storage and was not operated at any time during the
registration period for which the exemption is being claimed.
I declare that the gross vehicle weight is ________lbs. I am aware that giving false information is a criminal
offense, if audited and this information is not correct, I could be subject to criminal prosecution.
This vehicle has been previously titled as a lease vehicle. I/we request that the “lease” brand be removed from
the title certificate.
My name was entered in error as lienholder on above title. I do not hold any lien against this vehicle/vessel title.
This is to certify that the above vehicle will not be used on the public streets or highways in the United States and
insurance will be purchased when vehicle re-enters the United States.
License plate _______________ was ____ lost ____ destroyed ____ stolen. Therefore, the license plate is not
available for surrender. If found, the license plate will not be affixed to any motor vehicle.
COPY OF OWNER'S PHOTO ID MUST ACCOMPANY THIS FORM.
Other: _____________________________________________________________________________________
_____________________________________________________________________________________.
I understand that a person who knowingly makes a false declaration is guilty of the crime of perjury by false written
declaration, a felony of the third degree, punishable as provided in Florida Statutes 775.082, 775.083 and 775.084.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT
AND THAT THE FACTS STATED IN IT ARE TRUE.
____________________________________
Signature of Purchaser/Owner Signature of Co-Purchaser/Co-Owner
__________________
Date
____________________________________
PBCTC Form 138 (
11/16)
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Plate Surrender Missing PBCTC Form 138 11 8-2016 (Constitutional Tax Collector)

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Completed 11 April 2021

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