App. for Mult. Cert. of Title

Transcript

1 STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES IST SERVICES DIVISION OF MOTOR SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/ APPLICATION FOR MULTIPLE CERTIFICATES OF TITLE WITH/WITHOUT REGISTRATIONS (Instructions on Reverse Side) 1 APPLICANT IDENTIFICATION Owner/Lessor Name Sex Owner/Lessor Email Address Fleet # FEID # City Owner/Lessor’s Address Zip State Sex Lessee’s Name Lessee’s Email Address Date of Birth State Zip City Lessee’s Mailing Address City Zip Owner/Lessee’s Street Address in Florida (Mandatory) State TRANSFER TYPE AND STATUS 2 SALE IF OWNERSHIP HAS TRANSFERRED, HOW WERE VEHICLES OR VESSELS ACQUIRED? REPOSSESSION COURT ORDER OTHER (SPECIFY) _ ____________________ GIFT NEW USED LEASE: SHORT TERM LONG TERM PRIVATE TAXI CAB POLICE DATE ACQUIRED ___________________________ LIENHOLDER INFORMATION 3 FEID # Date of Lien Lienholder Name Lienholder Address City State Zip Lienholder Email Address (DOES NOT APPLY TO VESSELS) _______________________________________ If Lienholder authorizes the Department to send title to the owner, check box and countersign. ________________________________ If box above is not checked, title will be mailed to first lienholder. Signature of Lienholders Representative MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTIONS 4 YEAR BODY WEIGHT/LENGTH MAKE/MANUFACTURER O DOMETER STATUS I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE MILEAGE THAT I CHECKED IS THE TRUE AND CORRECT MILEAGE. INITIAL COLOR LICENSE PLATE VIN / HIN ODOMETER PREVIOUS PREVIOUS DATE TITLE NUMBER OR (IF VIN OF STATE * READING * * READ ISSUE REGISTRATION VERIFIED VEHICLE A N E DATE NUMBER BY OWNER) PROPULSION FUEL TYPE HULL MATERIAL 4. Inboard/Outboard 1. Open Motorboat 1. Wood 5. Houseboat 4. Fiberglass 1. Gas 1. Outboard 2. Diesel 6. Pontoon 5. Wood/Fiberglass 2. Cabin Motorboat 5. Air Propelled 2. Aluminum 2. Inboard 3. Other________ 3. Auxiliary Sailboat 6. Other__________ 3. Steel 6. Other_______ 7. Personal Watercraft 3. Sail Specify Specify Specify 4. Inflatable 8. Other ___________ Specify OWNER USE OF VESSEL LENGTH OF VESSEL OWNER - CO *DRAFT OF VESSEL (The depth of water a vessel draws) Are you a Florida 1. Pleasure yes yes no resident? 2. Dealer no FT. ________ IN.________ FT. _____ IN._____ 3. Manufacturer 4. Pleasure Canoe no yes yes no Are you an alien? 5. Commercial Canoe *For all vessels 26’ or more in length and all Contribution To Election Campaign Financing Trust Fund 6. Commercial sailboats 7. Exempt State Registration Number: Previously Federally Documented Vessel, Attach Copy of: Previous Out - of - 1. U.S. Coast Guard Release From Documentation Form; or 2. Copy of Canceled Documentation Papers 5 VEHICLE IDENTIFICATION NUMBER VERIFICATION COMPLETION OF THIS PART REQUIRES A PHYSICAL INSPECTION OF EACH MOTOR VEHICLE AND EACH VEHICLE IDENTIFICATION NUMBER (VIN) DESCRI BED ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, FLORIDA DIVISION OF MOTOR IST SERVICES EMPLOYEE OR FLORIDA TAX COLLECTOR EMPLOYEE. IF THE VINS ARE VERIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER, THE VERIFICATIONS MUST BE SUBMIT TED ON THEIR LETTERHEAD STATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING TRAILERS (WITH ABBREVIATION OF "TL" AND A WEIGHT OF 2,000 POUNDS OR MORE), NOT CURRENTLY TITLED IN FLORIDA. identification I, the undersigned, certify that I have physically inspected the above described vehicles and find vehicle identification numbers on each vehicle to be identical to the vehicle numbers recorded on this form. _ ____________________________________________ __________________________ ___________________________________________________ (DATE) (SIGNATURE) (PRINTED NAME) Law Enforcement, Agency Badge or Dealer #:__________________________ (Notary Stamp) _______________________________________________________ FL. or FL. Dealer's Name: Florida DMV/Tax Collector Employee: _________________________________________________ Florida Compliance Examiner/Inspector Badge or ID Number ___________________ Commissioned Name of Florida Notary: _____ ______________________________________________ Notary's Signature: __ ___________________________________________________________ HSMV 82039 (Rev. 12/11) S www.flhsmv.gov

2 6 SALES TA X EXEMPTION CERTIFICATION I CERTIFY THE MOTOR VEHICLES, MOBILE HOMES OR VESSELS (DESCRIBED ON SIDE 1 SIDE OF THIS FORM) HAVE BEEN PURCHASED AND IS EXEMPT FROM THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES BECAUSE: ______________________________________________________ PURCHASER (STATE AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE CONSUMER’S CERTIFICATE OF EXEMPTION NO. MOBILE HOMES VESSELS WILL BE USED EXCLUSIVELY FOR RENTAL ______________________________________________________ VEHICLES SALES TAX REGISTRATION NUMBER 7 DEALER SALES TAX REPORT DEALER / AGENT SIGNATURE FLORIDA SALES TAX REG NUMBER DATE OF SALE DEALER LICENSE NUMBER AMOUNT OF TAX, PER UNIT CERTIFICATION 8 THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT: __________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________ OF MY/OUR OWNERSHIP OF THE MOTOR VEHICLE S, MOBILE HOMES OR IN CONSIDERATION OF THE FOREGOING AND THE ATTACHED EVIDENCE SIDE 1 OF THIS FORM, I/WE REQUEST THAT TH E CERTIFICATE OF TITLE BE ISSUED IN TO M Y/OUR NAME. VESSELS DESCRIBED ON AGREE TO DEFEND THE TITLE AGAINST ALL CL I/WE FURTHER AIMS. TED IN IT ARE TRUE. UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STA _____________________________________________________________ _____________________________________ _______________________ Signature of Applicant (Owner) Printed Name Date _____________________________________________________________ _____________________________________ _______________________ Signature of Co- Applicant (Co-O wner) Printed Name Date _______________________________________________________________________________________________________ WHO IS AUTHORIZED TO COMPLETE THIS FORM?: ANY AUTHORIZED AGENT OF A COMPANY OR CORPORATION, REQUIRED TO MAKE APPLICATION FOR MULTIPLE FLORIDA CERTIFICATES OF TITLE. WHEN SHOULD THIS FORM BE USED?: WHEN A COMPANY OR CORPORATION IS APPLYING FOR MULTIPLE CERTIFICATES OF TITLE ON NEW OR USED MOTOR VEHICLES, MOBILE HOMES OR VESSELS WITH THE SAME YEAR, MAKE, BODY AND WEIGHT. FOR MOBILE HOMES AND VESSELS, BODY AND WEIGHT ARE EXCLUDED AND LENGTH IS INCLUDED. WHEN IS THE VIN VERIFICATION ON THIS FORM NOT NECESSARY?: THE VIN VERIFICATION ON THIS FORM DOES NOT HAVE TO BE COMPLETED ON VESSELS, MOBILE HOMES, TRAVEL TRAILERS, CAMPING TRAIL ERS, FIFTH WHEEL RECREATIONAL TRAILERS OR SEMI TRAILERS WITH A NET WEIGHT OF LESS THAN 2,000 POUNDS, WHEN A FLORIDA CERTIFICATE OF TITLE IS SUBMITTED AS PROOF OF OWNERSHIP OR WHEN FORM HSMV 82042 HAS BEEN COMPLETED AND IS ATTACHED. WHEN IS THE ODOMETER DECLARATION ON THIS FORM NOT NECESSARY?: THE ODOMETER DECLARATION IN SECTION 4 OF THIS FORM DOES NOT HAVE TO BE COMPLETED WHEN THE VEHICLE BEING TITLED IS EXEMPT EXEMPTIONS: HAS A GROSS VEHICLE FROM ODOMETER DISCLOSURE REQUIREMENTS. WHEN THE VEHICLE IS TEN YEARS OLD OR OLDER, WEIGHT (GVWR) OF MORE THAN 16,000 POUNDS OR IS NOT SELF PROPELLED. ODOMETER STATUS A - WHEN A CHECK MARK IS ENTERED UNDER THE “A” THE STATUS WILL BE SHOWN AS “ACTUAL MILEAGE.” ∗ ∗ WILL BE SHOWN AS “WARNING: NOT ACTUAL MILEAGE.” N - WHEN A CHECK MARK IS ENTERED UNDER THE “N” THE STATUS E - WHEN A CHECK MARK IS ENTERED UNDER THE “E” THE STATUS WILL BE SHOWN AS “EXCEEDS MECHANICAL LIMITS.” ∗ FILING: 1. ALL APPLICABLE SECTIONS OF THIS FORM MUST BE COMPLETED LEGIBLY. 2. UST BE FILED WITH THIS FORM. ONE OF THE FOLLOWING M FLORIDA CERTIFICATE OF TITLE. (A) (OR) (B) MANUFACTURER’S CERTIFICATE OF ORIGIN. (OR) (C) OUT -OF-STATE TITLE OR OTHER OFFICIAL PROOF OF OWNERSHIP. 3. THIS FORM MUST BE SIGNED BY AND INCLUDE THE PRINTED NAME OF AN AUTHORIZED AGENT OF THE COMPANY OR CORPORATION. SALES TAX THE SALES TAX EXEMPTION NUMBER OR CONSUMER’S CERTIFICATE OF EXEMPTION NUMBER MUST BE SHOWN IN SECTION 6 OF THIS FORM. -41A AND FORM HSMV 82042 HAVE BEEN MERGED INTO THIS FO RM. NOTE: FORMS DR40, DR Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/ HSMV 82039 (Rev. 12/11) S www.flhsmv.gov

Related documents