DMS Deal Number:

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION DMS Customer Number:
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 Owner Co-Owner Unit Number Fleet Number
the certificate of title to be printed.
Are you a Florida resident? yes no yes no
Are you an alien? yes no yes no
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: _____________________________________
Owner’s Name As It Appears 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 BHP/CC GVW/LOC VAN USE, IF APPLICABLE
Ft. In.
PASSENGER OTHER
TYPE HULL MATERIAL PROPULSION FUEL *DRAFT OF VESSEL
Open Motorboat Houseboat Personal Watercraft Wood Aluminum Outboard Sail Gas (The depth of water a
Cabin Motorboat Pontoon Canoe Fiberglass Steel Inboard Air Propelled Diesel vessel draws)
Auxiliary Sailboat Airboat Other _________ Wood/Fiberglass Inboard/Outboard Electric
FT. ______ IN. ______
Inflatable Sailboat Specify Other______________________ Other__________________________ Other_________________ *For all vessels 26’ or more in
Specify Specify Specify length and all sailboats
USE OF VESSEL PREVIOUS
Recreational (Pleasure) Commercial Blue Crab Commercial Stone Crab Government Commercial Sponge OUT-OF-STATE
Dealer/Manuf. Commercial Fish Commercial Live Bait Commercial Shrimp Recip. Commercial Charter Commercial Other ______________ REGISTRATION NUMBER:
Exempt Hire (Livery) Commercial Mackerel Commercial Shrimp Non-Recip. Commercial Oyster Commercial Spiney Lobster
Previously Federally Documented Vessel, Attach Copy of: State of Principal Use
U.S. Coast Guard Release From Documentation Form; or Copy of Canceled Documentation Papers
3 BRANDS, USAGE AND TYPE (Check Applicable Boxes)
SHORT TERM LEASE LONG TERM LEASE REBUILT POLICE VEHICLE PRIVATE USE TAXI CAB FLOOD ILEV CUSTOM
ASSEMBLED FROM PARTS BONDED TITLE KIT CAR GLIDER KIT MANUF. BUY BACK REPLICA AUTONOMOUS ELECTRIC STREET ROD
4 LIENHOLDER INFORMATION
CHECK Date of Lien Lienholder's Name
FEID # DL # and Sex and Date of Birth DMV Account #
IF ELT
CUSTOMER
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

0
YEAR OF TRADE IN MAKE OF TRADE IN TITLE NUMBER OF TRADE IN (IF KNOWN) VEHICLE IDENTIFICATION NUMBER OF TRADE IN

HSMV 82040 – REV. 11/15 RULE 15C-21.001, FAC www.flhsmv.gov

 8 MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATION
THIS 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
STATIONERY. 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
TITLED 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___________________________

COMMISSIONED NAME OF FLORIDA NOTARY: __________________________________________________ NOTARY'S SIGNATURE _________________________________________________

(Print, Type or Stamp)

9 SALES TAX EXEMPTION CERTIFICATION

THE 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)

10 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 APPLICATION 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

13 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:

Name of Applicant(s) (Print or Type)

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 RULE 15C-21.001, FAC
 STATE OF FLORIDA
HSMV 82995 (REV. ϭϬͬϭϭͿ^ DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES (Instructions on Reverse Side)
DIVISION OF MOTOR SERVICES
2900 Apalachee Parkway - Tallahassee, 32399-0610
MOTOR VEHICLE POWER OF ATTORNEY/ODOMETER DISCLOSURE
This form may be used when title is physically held by lienholder or when the title has been lost. This form must be submitted to the state by the person exercising
Powers of Attorney. Failure to do so may result in fines or imprisonment.
VEHICLE DESCRIPTION
Vehicle Identification Number Year Make Model Body Title No.

PART A. TRANSFEROR (SELLER’S) POWER OF ATTORNEY TO DISCLOSE MILEAGE.

I/We, appoint
(Print Seller’s Name) (Print Name of Dealership/Business)
as of as my/our attorney-in-fact with full authority to transfer title, to satisfy any lien and to disclose the milea ge for the vehicle
(Date)
described above, exactly as stated in the following disclosure.

WARNING: Federal law and State law require that you state the mileage in connection with transfer of ownership. Providing a false stat ement may result in
fines or imprisonment.

I/WE STATE THAT THIS 5DIGIT OR 6 DIGIT ODOMETER NOW READS, , xx (NO TENTHS) MILES,
DATE READ , AND I/WE HEREBY CERTIFY THAT TO THE BEST OF0<285.12:/('*(7+(2'20(7(55($',1*
1. REFLECTS ACTUAL MILAGE 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3. IS NOT THE ACTUAL MILEAGE
WARNING ODOMETER DISCREPANCY

Seller’s Signature Seller’s Printed Name

TRANSFEROR
(Seller):

Co Seller’s Signature Co Seller’s Printed Name

Seller’s Street Address City State Zip

Purchaser’s Signature Purchaser’s Printed Name

Purchaser’s Dealership Name Dealer License No.

TRANSFEREE
(Purchaser):

(Print Name of Dealership/Business)

Business Address City State Zip

PART B. TRANSFEREE (PURCHASER) POWER OF ATTORNEY TO REVIEW TITLE DOCUMENTS AND ACKNOWLEDGE DISCLOSURE. (PART B IS INVALID UNLESS PART A HAS BEEN COMPLETED.)

I/We, appoint
(Print Purchaser’s Name) (Print Name of Dealership/Business)
as of as my/our attorney-in-fact for the purpose of and with full authority to apply for title and/or registration, t o file a lien and
(Date)
to sign the mileage disclosure on the title for the vehicle described above, only if the disclosure is exactly as the disclos ure completed below.

WARNING: Federal law and State law require that you state the mileage in connection with transfer of ownership. Providing a false stat ement may result in
fines or imprisonment.
I/WE STATE THAT THIS 5DIGIT 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 MILAGE 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3. IS NOT THE ACTUAL MILEAGE
WARNING ODOMETER DISCREPANCY

Seller’s Signature Seller’s Printed Name

TRANSFEROR
(Seller):

(For Dealership / Business) (For Dealership / Business)

Business Address City State Zip

Purchaser’s Signature Purchaser’s Printed Name

TRANSFEREE
(Purchaser):

Co Purchaser’s Signature Co Purchaser’s Printed Name

Purchaser’s Name Street Address

City State Zip

PART C. CERTIFICATION BY ATTORNEY IN FACT (Person completing Part C must be the same person transferring information and signing the title.)
I, , hereby certify that the mileage I have disclosed on the title document is
(Print Name of Person exercising above power(s) of attorney)
consistent with that provided to me in the above power(s) of attorney. Further, upon examination of the title and any reassignment documents for the vehicle described
above, the mileage disclosure I have made on the title pursuant to the power of attorney is the same or greater than that previously stated on the title reassigned
documents. This certificate is not intended to create, nor does it create any new or additional liability under Federal or State law.

Signature Date Printed Name

Street Address City State Zip

ORIGINAL:DMS Copy (with Title) GOLD COPY:Dealer/Business YELLOW COPY:Part A Seller
WHO IS AUTHORIZED TO USE THIS FORM?:

OWNERS (SELLERS) TRANSFERRING THEIR OWNERSHIP IN THE MOTOR VEHICLE DESCRIBED ON THIS FORM TO A
PURCHASER WHO WILL USE THIS POWER OF ATTORNEY TO MAKE A REQUIRED ODOMETER DISCLOSURE ON
BEHALF OF THE SELLER (SELLERS MUST COMPLETE PART A WHEN TITLE IS NOT AVAILABLE FOR ODOMETER
DISCLOSURE.)

PURCHASERS OBTAININGOWNERSHIP OF THE MOTOR VEHILCE DESCRIBED ON THIS FORM FROM A LICENSED
MOTOR VEHILCE DEALER WILL USE THIS POWER OF ATTORNEY TO MAKE A REQUIRED ODOMETER DISCLOSURE ON
BEHLAF OF THE PURCHASER. (PURCHASER MUST COMPLETE PART B WHEN THE TITLECERTIFICATE IS NOT
AVAILABLE AND PART A HAS BEEN COMPLETED.)

DEALERS LICENSED IN THE STATE OF FLORIDA TO BUY AND SELL MOTOR VEHICLES WILL USE THE POWER(S) OF
ATTORNEY TO MAKE REQUIRED ODOMETER DISCLOSURES FOR MOTOR VEHICLE SELLERS AND/OR PURHCHASERS.
(DEALERS MUST ALWAYS COMPLETE PART C.)

THIS FORM SHOULD BE USED:

WHEN THE CERTIFICATE OF TITLE IS PHYSCIALLY HELD BY A LIENHOLDER AND IS NOT AVAILABLE FOR
ENDORSEMENT FOR TRANSFER AND ODOMETER DISCLOSURE.

WHEN THE CERTIFICATE OF TITLE HAS BEEN LOST OR DESTROYED AND IS NOT AVAILABLE FOR ENDORSEMENT FOR
TRANSFER AND ODOMETER DICLOSURE.

THIS FORM IS NOT REQUIRED:

WHEN THE MOTOR VEHICLE IS EXEMPT FROM THE ODOMETER DISCLOSURE REQUIREMENTS UNDER FEDERAL AND
STATE LAW. THESE EXEMPTIONS ARE:

- MOTOR VEHICLE IS TEN (10) YEARS OLD OR OLDER

- MOTOR VEHICLE IS NOT SELF PROPELLED
- MOTOR VEHICLE HAS A GROSS VEHICLE WEIGHT RATING (GVWR) OF MORE
THAN 16,00 POUNDS.

NOTE: IF A POWER OF ATTORNEY FORM IS NEEDED FOR AN EXEMPT VEHICLE (SEE ABOVE LIST OF EXEMPTONS),
USE FORM HSMV 82053.

FILING OF COPIES:

ORIGINAL: TO BE ATTACHED TO THE CERTIFICATE OF TITLE WHEEN OBTAINED AND IS TO REMAIN WITH THE TITLE
UNTIL THE APPLICATION FOR TITLE IS MADE FOR THE PURCHASER.

SECOND COPY: TO BE RETAINED BY THE DEALER FOR A PERIOD OF FIVE (5) YEARS.

THIRD COPY: TO BE GIVEN TO THE SELLER WHO COMPLETED THE POWER OF ATTORNEY IN PART A.

NOTE: IF THE MOTOR VEHICLE IS BEING SOLD TO AN OUT OF STATE PURCHASER OR AN OUT OF STATE DEALER,
THE FLORIDA DEALER MUST PHOTOCOPY THE COMPLETED ORIGINAL OF THIS FORM AND MAIL DIRECTLY TO THE
DEPARTMENT WITHIN FIVE (5) BUSINESS DAYS AFTER THE CERTIFICATE OF TITLE AND DEALER REASSIGNMENT
FORM ARE DELIVERED BY THE DEALER TO ITS PURCHASER.
 STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
2900 Apalachee Parkway
NEIL KIRKMAN BUILDING, TALLAHASSEE, FLORIDA 32399-0610

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

VEHICLE DESCRIPTION
Vehicle Identification Number Year Make Color Body Title Number

ODOMETER DISCLOSURE STATEMENT

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 and/or imprisonment.

WE STATE THAT THIS 5 or 6 DIGIT ODOMETER NOWS READS , .XX (NO TENTHS) MILES,
DATE READ ________/_______/________, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE
ODOMETER READING:
1. REFLECTS ACTUAL MILEAGE.
CAUTION:
Read carefully before 2. IS IN EXCESS OF ITS MECHANICAL LIMITS.(EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)
checking a box.
3. IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DISCREPANCY

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 Seller’s Printed Name

Seller’s Street Address

City State Zip

Buyer’s Signature Buyer’s Printed Name

/
Buyer’s Street Address

City State Zip

WHO IS AUTHORIZED TO COMPLETE THIS FORM?

ANY PERSON WHO IS BUYING OR SELLING A MOTOR VEHICLE AND WHO MUST MAKE OR ACKNOWLEDGE AN ODOMETER
DISCLOSURE, IN ORDER TO COMPLY WITH STATE OR FEDERAL ODOMETER DISCLOSURE LAW.
WHEN SHOULD THIS FORM BE USED?
1. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN SOLD.
2. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN PURCHASED.
3. WHEN AN ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT BETWEEN THE BUYER AND THE SELLER IS
REQUIRED, BUT NO ODOMETER DISCLOSURE STATEMENT HAS BEEN MADE ON ANOTHER STATE OR FEDERAL FORM.
WHEN SHOULD THIS FORM NOT BE USED?
1. WHEN A FLORIDA TITLE WHICH WAS ISSUED ON OR AFTER APRIL 29, 1990 IS AVAILABLE.
2. WHEN A FORM HSMV 82994, MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT, HAS BEEN USED.
3. WHEN A FORM HSMV 82995, MOTOR VEHICLE DEALER POWER OF ATTORNEY/ODOMETER DISCLOSURE, HAS BEEN USED.
4. WHEN AN OUT-OF-STATE TITLE, WHICH CONFORMS TO FEDERAL LAW, IS USED TO TRANSFER A MOTOR VEHICLE.
FILING:
1. COPIES SHOULD BE EXCHANGED BETWEEN THE SELLER AND THE BUYER. DEALERS MUST RETAIN THIS DOCUMENT IN THEIR
RECORDS FOR A PERIOD OF FIVE YEARS.
2. IT IS NOT NECESSARY TO FILE THIS FORM OR ANY COPY OF THIS FORM WITH THE STATE OF FLORIDA, UNLESS REQUESTED TO
DO SO BY THE DIVISION OF MOTOR VEHICLES.

HSMV 82993 (REV. 10/09) www.flhsmv.gov

 STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
2900 Apalachee Parkway
NEIL KIRKMAN BUILDING, TALLAHASSEE, FLORIDA 32399-0610

SEPARATE ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT

VEHICLE DESCRIPTION
Vehicle Identification Number Year Make Color Body Title Number

ODOMETER DISCLOSURE STATEMENT

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 and/or imprisonment.

WE STATE THAT THIS 5 or 6 DIGIT ODOMETER NOWS READS , .XX (NO TENTHS) MILES,
DATE READ ________/_______/________, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE THE
ODOMETER READING:
1. REFLECTS ACTUAL MILEAGE.
CAUTION:
Read carefully before 2. IS IN EXCESS OF ITS MECHANICAL LIMITS.(EXCESS OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS)
checking a box.
3. IS NOT THE ACTUAL MILEAGE. WARNING – ODOMETER DISCREPANCY

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 Seller’s Printed Name

Seller’s Street Address

City State Zip

Buyer’s Signature Buyer’s Printed Name

/
Buyer’s Street Address

City State Zip

WHO IS AUTHORIZED TO COMPLETE THIS FORM?

ANY PERSON WHO IS BUYING OR SELLING A MOTOR VEHICLE AND WHO MUST MAKE OR ACKNOWLEDGE AN ODOMETER
DISCLOSURE, IN ORDER TO COMPLY WITH STATE OR FEDERAL ODOMETER DISCLOSURE LAW.
WHEN SHOULD THIS FORM BE USED?
1. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN SOLD.
2. WHEN A MOTOR VEHICLE, FOR WHICH AN ODOMETER DISCLOSURE IS REQUIRED, HAS BEEN PURCHASED.
3. WHEN AN ODOMETER DISCLOSURE STATEMENT AND ACKNOWLEDGMENT BETWEEN THE BUYER AND THE SELLER IS
REQUIRED, BUT NO ODOMETER DISCLOSURE STATEMENT HAS BEEN MADE ON ANOTHER STATE OR FEDERAL FORM.
WHEN SHOULD THIS FORM NOT BE USED?
1. WHEN A FLORIDA TITLE WHICH WAS ISSUED ON OR AFTER APRIL 29, 1990 IS AVAILABLE.
2. WHEN A FORM HSMV 82994, MOTOR VEHICLE DEALER TITLE REASSIGNMENT SUPPLEMENT, HAS BEEN USED.
3. WHEN A FORM HSMV 82995, MOTOR VEHICLE DEALER POWER OF ATTORNEY/ODOMETER DISCLOSURE, HAS BEEN USED.
4. WHEN AN OUT-OF-STATE TITLE, WHICH CONFORMS TO FEDERAL LAW, IS USED TO TRANSFER A MOTOR VEHICLE.
FILING:
1. COPIES SHOULD BE EXCHANGED BETWEEN THE SELLER AND THE BUYER. DEALERS MUST RETAIN THIS DOCUMENT IN THEIR
RECORDS FOR A PERIOD OF FIVE YEARS.
2. IT IS NOT NECESSARY TO FILE THIS FORM OR ANY COPY OF THIS FORM WITH THE STATE OF FLORIDA, UNLESS REQUESTED TO
DO SO BY THE DIVISION OF MOTOR VEHICLES.

HSMV 82993 (REV. 10/09) www.flhsmv.gov

 STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR
VEHICLES DIVISION OF MOTORIST SERVICES
Neil Kirkman Building - Tallahassee, FL 32399-0500
MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT
(Instructions on Reverse Side)

This reassignment is supplement to: Title No.: State of Issue:

Manufacturer’s Statement or Certificate of Origin
Is the title electronic? Yes No
VEHICLE DESCRIPTION

Vehicle Identification Number Year Make Model Body

REASSIGNMENT INFORMATION

Name of Seller(s)/Agent (Print) DL/ID#, DMS ACCT#, FEID# DEALER/AUCTION LICENSE (if applicable)

Street Address City State Zip

Selling Price (If Applicable) Sales Tax Collected (If Applicable) Sales Tax Reg. No. (If Applicable)

Purchaser and Co-Purchaser's Printed Name(s) Date of Sale

Purchaser’s Address City State Zip

Co-Purchaser’s Address (If applicable) City State Zip

Auction Name (If applicable) Auction License Number State of License Date of Auction

Street Address City State Zip

ODOMETER DISCLOSURE STATEMENT

WARNING: FEDERAL AND STATE LAW REQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER OF
OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

I/WE STATE THAT THIS 5 OR 6 DIGIT ODOMETER NOW READS, , XX (NO TENTHS) MILES,
DATE READ , AND I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING.

CAUTION:
READ CAREFULLY 1) REFLECTS ACTUAL MILEAGE
BEFORE YOU 2) IS IN EXCESS OF ITS MECHANICAL LIMITS
CHECK A BOX 3) IS NOT THE ACTUAL MILEAGE.WARNING - ODOMETER DISCREPANCY
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT
AND THAT THE FACTS STATED IN IT ARE TRUE.

Printed name of seller(s)/Agent Seller(s)/Agent Signature

Printed name of Co-Seller (If applicable) Co-Seller Signature (If applicable)

Purchaser(s) Signature Co-Purchaser(s) Signature

Purchaser(s) Printed Name First, Full Middle or Maiden, Last Co-Purchaser(s) Printed Name First, Full Middle or Maiden, Last

NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS ASSIGNMENT AND ALL ASSIGNMENTS THAT FOLLOW.
ORIGINAL: SUBMIT WITH APPLICATION FOR TITLE

HSMV 82994 (REV. 04/14) S COPY: SELLER/DEALER RETAIN IN FILE

 WHEN SHOULD THIS FORM BE USED?

FORM HSMV 82994, MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT,

MUST BE USED:

1. with conforming Florida Certificate(s) of Title to make additional dealer

reassignments and odometer disclosures when all reassignment and odometer
disclosure spaces on the reverse side of the Certificate of Title have been used:

OR

2. with a non-conforming Certificate(s) of Title to make reassignments and odometer

disclosures;

OR

3. with conforming MCO, when the MCO is not available at the time of sale;

OR

4. with all out-of state non-conforming Certificate(s) of Title to make dealer

reassignments and odometer disclosures;

OR

5. when ownership is being transferred on an Electronic Certificate(s) of Title.

NOTE: This form should NOT be used wen the owner is transferring ownership on a
vehicle that does not have an electronic Certificate of Title. If the Certificate
of Title is NOT electronic, the “Transfer of Title By Seller” section must be
completed by the seller(s)/agent.

FILING:

1. The original HSMV 82994 is to be surrendered with the application for title.

2. The copy of the HSMV 82994 is to be retained by the dealer in his/her records for a
period of five (5) years. It is recommended that the individual seller(s) retain a copy of
this form for their records.

HSMV 82994 (REV. 04/14) S

 Vehicle Air Pollution Control Statement
Florida Law prohibits the operation, sale, lease, or transfer of title of any automobile or light-duty truck
(1975 or newer, 10,000 pounds gross vehicle weight or less) that has been tampered with. "Tampering"
means the dismantling, removal, or rendering ineffective of any air pollution control device or system
which has been installed on the vehicle by the vehicle manufacturer except to replace such device or
system with a device or system equivalent in design and function to the part that was originally installed
on the motor vehicle (316.2935, Florida Statutes).
As a motor vehicle dealer licensed to conduct business in the State of Florida, I hereby certify that the
following air pollution emission control devices and system of this vehicle, if installed by the vehicle
manufacturer or importer, have not been tampered with by me or by my agents, employees, or other
representatives. I also hereby certify that I or persons under my supervision have inspected this motor
vehicle and, based on said inspection, have determined that the air pollution control devices and systems
listed below, if installed by the vehicle manufacturer or importer, are in place and appear properly
connected and undamaged as determined by visual observation.
This certification shall not be deemed or construed as a warranty that any air pollution control device or
system of the vehicle is in functional condition, nor does the execution or delivery of this certification
create by itself grounds for a cause of action between the parties to this transaction.
MAKE: MODEL: BODY TYPE:

VIN: YEAR:

Transferor's (Seller's) Signature:

Transferor's (Seller's) Printed Name:

Transferor's (Seller's) Street Address:

City: State: Zip Code:

Date of Statement:

Transferee's (Buyer's) Signature:

Transferee's (Buyer's) Printed Name: /

Transferee's (Buyer's) Street Address:

City: State: Zip Code:

1975 – 1980 Model Year: 1981 or Newer Model Year

Catalytic Converter
Catalytic Converter
Fuel Inlet Restrictor
Fuel Inlet Restrictor
Unvented Fuel Cap
Unvented Fuel Cap
Exhaust Gas Recirculation System (EGR)
Air Pump and/or Air Injection System (AIS)
Fuel Evaporative Emissions System (EVP)
Stock No.
Form approved by the Department of Environmental Protection
HSMV 84058 S (01/08)
 ADDENDUM TO INSTALLMENT CONTRACT/LEASE CONTRACT
FOR BAILMENT OF VEHICLE

Customer Name:____________________________________________ Vehicle Stock Number:_______________________

Customer Name:____________________________________________
Date:____________________________

Vehicle Information Vehicle Type:  Motor Vehicle  Mobile Home  Vessel

Year:_____________ Make/Model:_____________________________ Color:________________ Body:_______________

Title No.:____________________ VIN: ________________________________________

This addendum to that certain retail installment sale contract or lease contract (hereinafter “Finance Agreement”), dated as
of the same date hereof, by and between the Dealer listed below and the undersigned buyer(s)/lessee(s) (hereinafter
“Obligor”) with respect to the Vehicle listed above (“Vehicle”), sets forth the terms of the delivery of the Vehicle to Obligor.

Dealer intends to assign the Finance Agreement to a third‐party Finance Source (“Finance Source”). If Dealer is unable to
assign the Finance Agreement to a Finance Source customarily used by Dealer upon terms and conditions satisfactory to
Dealer, or if any statements in Obligor’s credit application are not true and correct, Dealer may rescind the sales transaction
between Obligor and Dealer, and Obligor shall return the Vehicle to the Dealer in the condition in which Obligor received it,
ordinary wear and use excepted.

If Dealer elects to rescind the sale to Obligor, Dealer shall so notify Obligor, and upon demand, Obligor shall immediately
return the Vehicle to the Dealer at Dealer’s place of business. Obligor shall pay Dealer for any damage to, destruction of,
abuse of, excessive wear and tear or “excessive mileage and use” of the Vehicle while in Obligor’s possession. “excessive
mileage and use” as described herein means when the total miles the Vehicle is driven, while in Obligor’s possession
exceeds an average of 50 miles for each day in Obligor’s possession. If the sum of all miles driven by buyer(s)/lessee(s)
exceeds this average daily total, Obligor shall pay, upon demand, $0.55 per mile to the Dealer for every mile exceeding the
sum of the daily average use (“mileage fee”). Obligor shall pay the mileage fee together with any other amounts for
damage, destruction or abuse to the Vehicle (“return costs”). Any funds of Obligor on deposit with or in the possession of
Dealer (“deposit monies”) shall be applied to the return costs due Dealer. If the deposit monies are insufficient to pay the
return costs, Dealer shall collect the unpaid amounts from Obligor, and in doing so, may seek legal relief. Upon Obligor’s
satisfaction of all of Obligor’s obligations set forth in this addendum, Dealer will return to Obligor all cash and trade‐in
amounts paid by Obligor to Dealer in connection with the Finance Agreement.

If the Finance Agreement contains a “seller’s right to cancel” provision, contract cancellation provision, or other provision
that addresses termination of the contract if Dealer is not able to assign the Finance Agreement and such provision is
enforceable, this addendum shall not be effective, and such provision shall apply.

Except as modified herein, all other terms of the finance contract are hereby ratified and reaffirmed, and remain in full
force and effect.

Name of Dealer: _________________________________________

___________________________________________ ___________________________________________
Customer Signature Customer Signature

___________________________________________
Dealer Signature

Copyright © 2011, Title Technologies, Inc. All rights reserved.

The printer of this form makes no warranty, express or implied, as to content or fitness for purpose of this form. Pleases consult your legal counsel.
 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/

POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL

___________________________
(Date)

I/We hereby name and appoint, __________________________________________________________, to be my/our

(Full Legibly Printed Name is Required)
lawful attorney-in-fact, to act for me/us, in applying for an original or duplicate certificate of title, to register, transfer title,
or record a lien to the motor vehicle, mobile home or vessel described below, and to print my/our name and sign their
name, in my/our behalf. My attorney-in-fact can also do all things necessary to the application or any other related
instrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do, were I/we personally present
and signing the same.
With full power of substitution and revocation, I/we hereby ratify and confirm whatever my/our said attorney-in-fact may
lawfully do or cause to be done in the virtue hereof.

CHECK ONE: Motor Vehicle Mobile Home Vessel

Year Make/Manufacturer Body Type Title Number

Vehicle/Vessel Identification Number

NOTICE TO OWNER(S): COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.

UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND
THAT THE FACTS STATED IN IT ARE TRUE.

_________________________________________________ __________________________________________________
(Signature of Owner "Grantor”) (Legibly Printed Name of Owner "Grantor")

________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Owner) (Date of Birth for Owner, if applicable)

________________________________________________________________________________________________________
(Owner’s Address ) (City) State) (Zip)

_________________________________________________ __________________________________________________
(Signature of Co-Owner "Grantor,” if applicable) (Legibly Printed Name of Co-Owner "Grantor," if applicable)

________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Co-Owner) (Date of Birth for Co-Owner, if applicable)

________________________________________________________________________________________________________
(Co-Owner’s Address) (City) (State) (Zip)

This non-secure power of attorney form may be used when an individual or entity appointed as the attorney-in-fact will
be completing the odometer disclosure statement as the buyer only or the seller only. However, this form cannot be
used to allow an individual or entity (such as a dealership) to sign as both buyer and seller for the purpose of disclosing
the odometer reading. This may be accomplished only with the secure power of attorney (HSMV 82995) when:
(a) the title is physically being held by the lienholder; or
(b) the title is lost.
NOTE: A licensed dealer and his/her employees are considered a single entity.

Check your local phone book government pages or visit the following website for current mailing addresses:
http://www.flhsmv.gov/offices/
HSMV 82053 (Rev. 12/11) S www.flhsmv.gov
 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/

POWER OF ATTORNEY FOR A MOTOR VEHICLE, MOBILE HOME OR VESSEL

___________________________
(Date)

I/We hereby name and appoint, __________________________________________________________, to be my/our

(Full Legibly Printed Name is Required)
lawful attorney-in-fact, to act for me/us, in applying for an original or duplicate certificate of title, to register, transfer title,
or record a lien to the motor vehicle, mobile home or vessel described below, and to print my/our name and sign their
name, in my/our behalf. My attorney-in-fact can also do all things necessary to the application or any other related
instrument and to bind me/us in as sufficient a manner as I/we myself/ourselves could do, were I/we personally present
and signing the same.
With full power of substitution and revocation, I/we hereby ratify and confirm whatever my/our said attorney-in-fact may
lawfully do or cause to be done in the virtue hereof.

CHECK ONE: Motor Vehicle Mobile Home Vessel

Year Make/Manufacturer Body Type Title Number

Vehicle/Vessel Identification Number

NOTICE TO OWNER(S): COMPLETE THIS FORM IN ITS ENTIRETY PRIOR TO SIGNING.

UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE READ THE FOREGOING DOCUMENT AND
THAT THE FACTS STATED IN IT ARE TRUE.

_________________________________________________ __________________________________________________
(Signature of Owner "Grantor”) (Legibly Printed Name of Owner "Grantor")

________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Owner) (Date of Birth for Owner, if applicable)

________________________________________________________________________________________________________
(Owner’s Address ) (City) State) (Zip)

_________________________________________________ __________________________________________________
(Signature of Co-Owner "Grantor,” if applicable) (Legibly Printed Name of Co-Owner "Grantor," if applicable)

________________________________________________________________________________________________________
(Driver License, Identification Card or FEID Number for Co-Owner) (Date of Birth for Co-Owner, if applicable)

________________________________________________________________________________________________________
(Co-Owner’s Address) (City) (State) (Zip)

This non-secure power of attorney form may be used when an individual or entity appointed as the attorney-in-fact will
be completing the odometer disclosure statement as the buyer only or the seller only. However, this form cannot be
used to allow an individual or entity (such as a dealership) to sign as both buyer and seller for the purpose of disclosing
the odometer reading. This may be accomplished only with the secure power of attorney (HSMV 82995) when:
(a) the title is physically being held by the lienholder; or
(b) the title is lost.
NOTE: A licensed dealer and his/her employees are considered a single entity.

Check your local phone book government pages or visit the following website for current mailing addresses:
http://www.flhsmv.gov/offices/
HSMV 82053 (Rev. 12/11) S www.flhsmv.gov
 FLORIDA INSURANCE AFFIDAVIT

Under penalty of perjury, I __________________________________________ certify that I have

(Name of Insured)

Personal Injury Protection, Property Damage Liability, and, when required, Bodily Injury Liability

Insurance currently in effect with _____________________________________________ under

(Name of Insurance Company)

__________________________ ____________________ covering the following motor vehicle:

(Policy Number) Company Code Number (5 digits)

_________________________________________________________________________________________________________
Year Make Vehicle Identification Number

This insurance company is licensed to issue insurance policies in Florida. I understand that my
driver license, license plate(s) and registration(s) will be suspended effective from the registration
date, if the insurer denies that this policy is in force.

_______________________________________
Signature of Insured

WARNING: GIVING FALSE INFORMATION IN ORDER TO OBTAIN A VEHICLE REGISTRATION

CERTIFICATE IS A CRIMINAL OFFENSE UNDER FLORIDA LAW. ANYONE GIVING
FALSE INFORMATION ON THIS AFFIDAVIT IS SUBJECT TO PROSECUTION.

HSMV 83330 (Rev. 09/09) www.flhsmv.gov

 t21 Deal Report

General Information
EFS ID: Sale Date:
Dealership: Stock #:
Deal #: New or Used Vehicle:
Actions Required: Vehicle Type:
Vehicle Title Use: Title Type:
Vehicle Registration Use: Reg Only Reason:
How Many Owners?: How Many Lienholders?:
Courtesy Delivery: Sale Price (Taxable Value):
Vehicle Information

VIN: Make: Cubic Centimeters:

Year: Model: Length (Inches):
Body: DMV Vehicle #: Length (feet):
Net Weight: Est. Net Weight: Transfer Tag:
Est. Gross Vehicle Weight: Vehicle Color: Plate Issued:
Gross Vehicle Weight: Decal Number: Purchase Vehicle Tag:
Brake Horsepower: Odometer: Plate Type:

Customer 1 Information
Customer Type: FL Customer #:
FEID #: Company Name:
Last Name: First Name: Middle Name: Suffix:
FL DL#: Date of Birth: Gender: Military:
Address: City:
State: Zip: County:

Customer 2 Information
Customer Type: FL Customer #:
FEID #: Company Name:
Last Name: First Name: Middle Name: Suffix:
FL DL#: Date of Birth: Gender: Military:
Address: City:
State: Zip: County:

Lienholder Information
Lienholder Name:
FEID #: Customer #:
Address: City:
State: Zip: County:

Fee Information

Reported Sales Tax:

Registration Fees Sales Tax (Courtesy Delivery):
Registration Expiration date:
Title Fees

Total Fees 0
 Hope Scholarship Program DR-HS1
R. 05/19
Contribution Election Rule 12AER19-01, F.A.C.
Effective 05/19
Page 1 of 1

The Hope Scholarship Program (Program) provides a public-school student who was subjected to an incident
of violence or bullying at school the opportunity to apply for a scholarship to attend an eligible private school
rather than remain in an unsafe school environment.
When you purchase or register a motor vehicle qualifying for the Program in Florida, you may designate $105
per vehicle to an eligible nonprofit scholarship-funding organization participating in the Program. If the state
sales tax due is less than $105, you may designate the amount of state sales tax due. Your motor vehicle
dealer, county tax collector, or private tag agent will remit your contribution to the organization and remit the
remaining state sales tax and surtax to the Florida Department of Revenue.
Eligible contributions are used to fund scholarships for the Hope Scholarship Program. Contributions may also
be used to fund scholarships for the Florida Tax Credit Scholarship Program, which provides a low-income
student the opportunity to apply for a scholarship to attend an eligible private school.

To make your contribution to the Program, complete the following. Sign and date.

Eligible Nonprofit Scholarship-Funding Organization: Contribution Amount

(Lesser of $105, or
Step Up for Students, Inc. state sales tax due):

Vehicle Owner's Name:

Mailing Address:

City: State: ZIP:

Vehicle Co-Owner's Name:

Mailing Address:

City: State: ZIP:

Vehicle Year: Vehicle Manufacturer: Vehicle Identification Number:

Signature of Owner: Date:

Signature of Co-Owner*: Date:

* For vehicles owned by more than one person, the signature of the owner and the co-owner is required.

For use by motor vehicle dealer, county tax collector, or private tag agency.