PPT-Florida Department of Highway Safety and Motor Vehicles

ECitation and ECrash Workgroup Our Mission Providing Highway Safety and Security through Excellence in Service Education and Enforcement Uniform Traffic Citations ECitations Electronic systems provide a quantifiable financial benefit by removing clerical data entry requirements improving officer efficiency and safety and increasing revenue by producing more accurate enforceable citations . The purchasers 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 MakeManufacturer Body Type Model Color Certificate o e car truck trailer Body Type 4D SW etc Florida Title Number Vehicle Identification Number 2 AFFIDAVIT OF VEHICLE OWNERSHIP PrintedTyped Name of the ApplicantOwner PrintedTyped Name of the CoApplicantOwner if applicable Date the Vehicle was Acquired Exam Date Signature of Eye Specialist Physician Li cense Number Business Address Form not valid after 1 year from exam date Telephone Date Corrective Lenses Issued Signature of Eye Associate Business Address Telephone Number PLEASE ALLOW A WEEK PROCESSING TIME FROM THE DATE WE RECEIVE THIS REQUEST HSMV 90511 Revised Requesters Information Name of Requester Date Reference CaseFile Name Mailing Address To receive personal information indicate the appropriate number s fro flhsmvgovoffices CHECK APPLI CATION TYPE RIGINAL RANSFER VEHICLE TYPE MOTOR VEHICLE MOBILE HOME VESSEL OFF HIGHWAY VEHICLE ATV ROV MC OWNER APPLICANT INFORMATION Customer Number Check this box if you are requesting the certificate of title to be pri Application for Registration of a Street Rod, Custom Vehicle, Horseless Carriage or Antique (Permanent) INSTRUCTIONS: COMPLETE APPLICATION AND CHECK APPLICABLE BOX 1 APPLICANT INFORMATION Name of Ap 4 4 4 4 4 4 4 4 SECTIONS 1 AND 2 SHOULD BE COMPLETED IF ADDING AN ORIGINAL LIEN. MOTOR VEHICLE SECTIONS 1 AND 3 SHOULD BE COMPLETED IF REASSIGNING A LIEN. SECTIONS 1, 2 AND 4 SHOULD BE COMPLETED AFFIDAVIT FOR TRANSFER/SALE Date of Application: ______________________ I (We) hereby certify that the below described vessel which is currently titled in the name(s) of Name and Address of individua 4 4 4 4 4 4 Motor Vehicle Mobile Home TITLE NUMBER IDENTIFICATION NUMBER YEAR MAKE/MANUFACTURER COLOR TYPE The records from the Division of Motorist Services listed my name as the 4 4 4 4 DIVISION OF MOTORIST SERVICES 2900 Apalachee Parkway Neil Kirkman Building - Tallahassee, FL 32399 CERTIFICATION OF ADDRESS Date I do hereby certify that : Name (First) (Middle) (Last) Dat e Year: Make/Manufacturer: Body Type: Color: Registered Owner(s)Name(s): (Last Name First)Date of Issue: Street Address: FIRST LIENHOLDER Lien Date: (month 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 ) Instructions onReverse Side Check this box if you are requesting the certificate of title Concentrate . On. Commercial Motor Vehicles (CMV). Trucks. Busses. History. 1913 . Lincoln Highway. 1916 . 1. st. Federal Aid Legislation. 1919 . Army . Convoy took 62 days. 1921 . 2. nd. . Federal Aid Legislation. 4444444444444444444444444444444444444444444444444444444444444444444444444444444444SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE wwwflhsmvgov/offices/ CHECK APPLICATION TYPERIGINAL RANSFER VEHICL