Notification of Dispute of Registration Fees Paid to a Dealer for a Motor Vehicle

If you want to notify the Department of Highway Safety and Motor Services of the questionability of the fees paid for registering a vehicle, the Notification of Dispute of Registration Fees Paid to a Dealer for a Motor Vehicle has to be used.

Extracted Text for Proper Search

STATE OF FLORIDA 
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES 
DIVISION OF MOTORIST SERVICES 2900 Apalachee Parkway, MS-72  Tallahassee, FL 32399 	
 
Notification of Dispute of Registration Fees  Paid to a Dealer for a Motor Vehicle  
In accordance with section 320.02(16)(a), Florida Statutes,  this statement serves as notice to the department that 
registration fees for the vehicle described below are in dispute. 
 
Title Number  Identification Number  Date Purchased 
Year: Make Color  Type: 
 
Owner’s Name:  Co-Owner’s Name: 
Owner’s Address: Co-Owner’s Address: 
City                                                                  State            Zip  City                                                           State                  Zip 
Owner’s Telephone Number: Co-Owner’s Telephone Number: 
 
Dealer’s Name:  Dealer License Number: 
Dealer Address: Dealer Phone Number: 
Registrations Fees Due $ Fees Collected $ 
 
Explanation of disputed registration fees:   
 
 
 
 
 
 
________________________________________________________________   _________________________ 
Signature(s)          Date 
 
To be completed by Division of Motorist Services	 	 
Registration was withheld   Yes   No  
Motor Vehicle Owners were notified of dispute on ______________________________  
Dispute settled on __________________________________  
Proper registration fees paid on ________________________   Amount Paid $_______________  
Registration mailed to owners on ___________________________ 
 
HSMV 82078 (07/11) S           	www.flhsmv.gov