Application for Certificate of Title With and Without Registration

Acquiring a certificate of title for a vehicle requires the use of the following application by the vehicle’s owner.

Extracted Text for Proper Search

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES  	
APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION  	
SUB MIT THIS FORM TO 	YOUR	 L OCAL  TAX COL L ECTOR OFFICE	 	www.flhsmv.gov/offices/	 	
CHECK APPLICATION TYPE	:  	 ORIGINAL   	TRANSFER    	VEHICLE TYPE	:  	   MOTOR VEHICLE   	 MOBILE HOME   	 VESSEL     	OFF-HIGHWAY VEHICLE	:  	AT V  	 ROV 	 MC  	  1 	 	OWNER / APPLICANT INFORMATION	 	Customer Number	 	Check this box if 	you 	are requesting 	the certificate of title to  be printed.    	Owner	   	Co-Owner	 	
Are you a Florida resident? 	yes  	no 	yes   	no 	 Are you an alien?	 	yes  	no 	yes   	no 	 	
Unit Number	 	Fleet Number	 	
Iiiiiii 	OR   	 AN D     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 A	ppears 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 m ember 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.   	
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 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	 	Vehic	le/Vessel Identification Number	 	Make/Manufacturer	 	Year	 	Body	 	Color	 	Florida Title Number	 	
 Previous State of Issue	 	 License Plate or Vessel Registration Number	 	 W eight	 	 Length	 	Ft.               In. 	
 BHP/CC	 	 GVW /LOC	 	 VAN USE, IF APPLICABLE	 	
  PASSENGER	 	  OTHER	 	
TYPE	 	  Open Motorboat	 	  Houseboat  	  Personal Watercraft	 	  Cabin Motorboat	 	  Pontoon 	  Canoe 	  Auxiliary Sailboat	 	  Airboat	 	  Other	 _________	 	  Inflatable 	  Sailboat   Specify	 	
HULL MATERIAL	 	  Wood 	  Aluminum	 	  Fiberglass 	  Steel	 	  Wood/Fiberglass	 	  Other______________________	 	Specify	 	
PROPULSION	 	  Outboard 	  Sail	 	  Inboard 	  Air Propelled	 	  Inboard/Outboard	 	  Other__________________________ 	Specify	 	
FUEL	 	  Gas   Diesel    Electric	 	  Other_________________	 	Specify 	
*DRAFT OF VESSEL	 	(The depth of water a  vessel draws)  
FT. 	______	    IN.	 ______	 	*For all  vessels 26’ or more in length and all sailboats	 	USE OF VESSEL	 	  Recreational (Pleasure)               	  Commercial Blue Crab 	  Commercial Stone Crab 	  Government 	  Commercial Sponge 	  Dealer/Manuf.  	  Commercial Fish   	  Commercial Live Bait  	  Commercial Shrimp Recip.  	  Commercial Charter 	  Commercial Other ______________ 	  Exempt  	  Hire (Livery)            	  Commercial Mackerel  	  Commercial Shrimp Non- Recip.  	  Commercial Oyster  	  Commercial Spiney Lobster  	 	
PREVIOUS 	 	OUT-OF-STATE REGISTRATION NUMBER:  	
Previously Federally Documented Vessel, Attach Copy of:	 	
  U.S. Coast Guard Release From Documentation Form; or 	  Copy of Canceled Documentation Papers  	 	
State of Principal Use	 	
3	BRANDS, USAGE AND TYPE (Check Applicable Boxes)	 	
SHORT TERM LEASE 
ASSEMBLED FROM PARTS 	
LONG TERM	 LEASE 	
BONDED TITLE 	
REBUILT 
KIT CAR 	
 	POLICE VEHICLE 
GLIDER KIT  	
 	PRIVATE USE               
MANUF. BUY BACK 	
 	TAXI CAB  
REPLICA 	
FLOOD  
AUTONOMOUS   	
ILEV  
ELECTRIC	 	
CUSTOM  
STREET ROD	 	 4 	LIENHOLDER	 INFORMATION	 	 	 CHECK   IF ELT  CUSTOMER	 	  	
FEID #    	 DL # and Sex and Date of Birth    	 DMV Account #	 Date of Lien	 	Lienholder's Name	 	
  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 imprisonmen t.	 	 
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 KNOWLEDG E 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  	
 YEAR OF TRADE IN 	 MAKE OF TRADE IN 	 TITLE NUMBER OF TRADE IN (IF KNOW N) 	 VEHICLE IDENTIFICATION NUMBER OF TRADE IN 	
 www.flhsmv.gov	  HSMV 82040 – REV. 11/15 RULE 
15C-21.001, 
FAC

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 MO TOR VEHICLES MANUFACTURED	 
PRIOR TO 1955	)  OF THE MOTOR VEHICLE DESCRIBED ON THIS FORM BY A LICENSED DEAL ER, 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 DE ALER, 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 POUND S OR MORE) NOT CURRENTLY 	TITLED IN FLORIDA.  I, the undersigned, certify that I have physically inspected t he above described vehicle and find the vehicle identification nu mber 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, ET C.) 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 a ddress, 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 MOTO R VEHICLE OR MOBILE HOME IN LIEU OF A TITLE (REPOSSESSION).  I AM REQUESTING THAT A DUPLICATE CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEH ICLE 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 O PERATED ON THE STREETS AND HIGHWAYS OF THIS STATE	 UNTIL PROPERLY REGISTERED .  	
THE VESSEL IDENTIFIED WILL NOT BE OPER ATED ON THE WATERS OF THIS STATE UNTIL PROPERLY REGISTERED.
OTHER: (EXPLAIN)  _______________________________________________________________________\
__________________________________________________________________________________	
12 	APPLICATION ATTESTMENT AND SIGNATURES	 	 	I/WE PHYSICALLY INSPECTED THE ODOMETER/VIN AND FURTHE R 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 vehi cle, 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 t he aforesaid motor vehicle, mobile home or vessel to: 
RESIDENTS OF FLORIDA AND ALL VESSEL OWNERS, RESI DING IN FLORIDA OR OUT OF STATE, SHOULD SUBM IT 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 governmen t pages or visit the following website for current mailing addresses : http://www.flhsmv.gov/offi ces/	
 	www.flhsmv.gov	   
HSMV 82040 – REV. 11/15	
Name of Applicant(s) (Print or Type) RULE 15C-21.001, 
FAC