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/
APPLICATION FOR DUPLICATE OR LOST IN TRANSIT/REASSIGNMENT FOR A
MOTOR VEHICLE, MOBILE HOME OR VESSEL TITLE CERTIFICATE
1 TYPE OF APPLICATION
VEHICLE/VESSEL
DUPLICATE:
(Fee Required)
VEHICLE/VESSEL
LOST IN TRANSIT:
NOTE: No fee required if vehicle application
is made within 180 days from last title
issuance date and has been lost in mailing.
LOST STOLEN
Damaged
(Certificate of Title must be submitted)
NOTE: An indication of lost, stolen or damaged is required.
VEHICLE/VESSEL DUPLICATE WITH TRANSFER:
(Both parties must be present for this transaction)
AND NOTE: When joint ownership, please indicate if “or” or OR
“and” is to be shown on the title when issued. If neither box is checked, the
title will be issued with “and”.
OWNER’S NAME (Last, First, Middle Initial) Owner’s E-Mail Address PURCHASER’S NAME (Last, First, Middle Initial) Purchaser’s E-Mail Address
CO-OWNER’S NAME (Last, First, Middle Initial) Co-Owner’s E-Mail Address
CO-PURCHASER’S NAME (Last, First, Middle Initial)
Co-Purchaser’s E-Mail Address
OWNER’S MAILING ADDRESS PURCHASER’S MAILING ADDRESS
CITY STATE ZIP CITY STATE ZIP
CAUTION: IF ADDRESS DIFFERS FROM DMV RECORDS,
ADDRESS VERIFICATION MUST BE SUBMITTED
DATE OF BIRTH PURCHASER’S DL/ID # CO-PURCHASER’S DL/ID#
APPLICATION FOR DUPLICATE IS MADE BY:
Owner
LIENHOLDER DATE OF LIEN
MOTOR VEHICLE MOBILE HOME OR RECREATIONAL VEHICLE DEALER/
AUCTION LICENSE NUMBER (
DEALER/AUCTION LICENSE NUMBER DOES NOT APPLY TO VESSELS:
LIENHOLDER OR DEALER/AUCTION NAME:
ADDRESS: CITY: STATE: ZIP:
MOTOR VEHICLE, MOBILE HOME OR VESSEL DESCRIPTION
Vehicle/Vessel Identification Number
License Plate or Vessel Registration Number
SHORT TERM LEASE
REPLICA
LONG TERM LEASE
KIT CAR
POLICE VEHICLE
REBUILT
PRIVATE USE
ASSEMBLED FROM PARTS
TAXI
FLOOD
MANUFACTURER’S BUY BACK
FEID # DL# & Sex and Date of Birth DMV Account #
Lienholder E-Mail Address Lienholder Mailing Address City State Zip
If Lienholder authorizes the Department to send title to the owner, check box and countersign.
If this box is not checked, title will be mailed to the first lienholder.
(DOES NOT APPLY TO VESSELS)
(Signature of Lienholders Representative)
APPLICATION ATTESTMENT/SIGNATURES AND ODOMETER DECLARATION/DISCLOSURE
WARNING: Federal and state law require that you state the mileage in connection with an application for Certificate of Title. 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:
CAUTION: READ CAREFULLY BEFORE YOU CHECK A BOX
1. REFLECTS ACTUAL MILEAGE.
2. IS IN EXCESS OF ITS MECHANICAL LIMITS. (EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)
3. IS NOT THE ACTUAL MILEAGE. WARNING - ODOMETER DISCREPANCY
I CERTIFY THAT THE MOTOR VEHICLE/VESSEL DESCRIBED ABOVE WILL NOT BE OPERATED ON THE STREETS AND HIGHWAYS/WATERWAYS OF
THIS STATE AND NO FLORIDA LICENSE PLATE HAS BEEN TRANSFERRED TO OR PURCHASED FOR THIS MOTOR VEHICLE.
I am/we are the owner(s), lienholder(s), and am legally authorized to apply for and receive the Duplicate Certificate of Title. I/we further agree to
indemnify the Department and defend the Certificate of Title against all actions or claims by any person.
UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
IF APPLICABLE, I ATTEST TO HAVING
Date Sold Selling Price $
ACQUIRED THE MOTOR VEHICLE, MOBILE
PURCHASE GIFT INHERITANCE COURT ORDER
HOME OR VESSEL DESCRIBED ABOVE BY:
Signature of
Purchaser: _______________________________________________________________________
Signature of
Co-Purchaser: _____________________________________________________________________
Signature of Seller/
Owner/Lienholder: __________________________________________________________________
Signature of
Co-Owner: ________________________________________________________________________
Printed Name
of Purchaser: _______________________________________________________________________
Printed Name of
Co-Purchaser’s: _____________________________________________________________________
Printed Name of
Seller/ Owner/Lienholder: ______________________________________________________________
Printed Name of
Co-Owner: __________________________________________________________________________
FOR FLORIDA DMV OR TAX COLLECTOR/LICENSE PLATE AGENCY USE ONLY
Duplicate authorization
HSMV 82101 (Rev. 01/13/21) www.flhsmv.gov