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General Title Questions
Completed ‘Personal Information Section’
Completed Certificate of Title
Copy of Driver License
Title Application Form
Copy of Florida Insurance Card
Current Registration
‘Part A’ of VIN Verification
Completed ‘Personal Information Section’
Completed Certificate of Title
Copy of Driver License
Duplicate Title Application
Copy of Florida Insurance Card
Current Registration
Electronic Title Request Form
PERSONAL INFORMATION SECTIONVehicle Owner Name
Vehicle Identification Number(VIN)Phone Number
Mailing Address
TO TRANSFER A TITLE(new owner)
TO OBTAIN A TITLE (current owner)
David W. Jordan Lake County Tax Collector P.O. Box 268 Tavares,
FL 32778 352-343-9602 laketax.com
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B. Obtaining a title:
To obtain an electronic title: You can go online to
www.gorenew.com. -OR- To obtain a paper title: 1 Complete the
‘Personal Information Section’ on the first page of the packet. 2
Complete the ‘Duplicate Title Application’ form located within the
packet.3 Complete the ‘Electronic Title Form’ located within the
packet.4 Enclose a voided check.5 Return this packet along with the
required documents to the Tax Collector’s Office. (last page)
1 Complete the front of the title. (Make sure title is signed by
BOTH seller and buyer. Complete current odometer reading and
selling price.)
A. How to transfer a title:
TRANSFER OF TITLE BY SELLER (This section must be completed at
the time of sale.)ODOMETER CERTIFICATION - Federal and state law
require that you state the mileage in connection with the transfer
of ownership. Failure to
completeorprovidingafalsestatementmayresultinfinesand/orimprisonment.Thistitleiswarrantedandcertifiedtobefreefromanyliensexceptasnotedonthefaceofthiscertificateandthemotorvehicleorvesseldescribedisherebytransferredto
Purchaser_______________________________________________________________________________
Address____________________________________________________________
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE
FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
CAUTIONDO NOT CHECKBOX IF ACTUAL
MILEAGE
1.Iherebycertifythattothebestofmyknowledgetheodometerreadingreflectsthe
amountofmileageinexcessofitsmechanicallimits. 2. I hereby certify
that the odometer reading is not actual mileage. WARNING - ODOMETER
DISCREPANCY.
Signature of Purchaser:Signature of Co-Purchaser: Signature of
Seller: Signature of Co-Seller: (When Applicable)
SellingDealer’sLicenseNumberTaxNo.TaxCollected$
Auction Name License Number
Seller and buyer signature.
SellingPrice$_____________________________DateSold______________________I/Westatethatthis5or6digitodometernowreads,(no
tenths) miles,dateread______________andtothebestofmyknowledge
thatitreflectstheactualmileageofthevehicledescribedherein,unless
one of the odometer statement blocks is checked.
.XX
Complete Odometer Reading Complete Selling Price
Printed Name of Purchaser:Printed Name of Co-Purchaser: Printed
Name of Seller: Printed Name of Co-Seller: Seller and buyer printed
name.
2 Complete the ‘Personal Information Section’ on the first page
of the packet. 3 Complete the HIGHLIGHTED sections on the Title
Application form located inside the packet. Sections 1, 2, 4 (if
applicable), 6 and 124 If vehicle is NOT titled in Florida,
complete ‘Part A’ of the VIN Verification form. 5 Enclose a voided
check. 6 Return this packet along with the required documents to
the Tax Collector’s Office. (last page)
For information on fees go to: www.flhsmv.gov/fees/
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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION
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
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
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." OR 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 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 imprisonment.
I/WE STATE THAT THIS 5 OR 6 .XX (NO TENTHS) _____ /_____ /
________ DIGIT ODOMETER NOW READS 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
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
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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, t
he 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:
_____________________________(Print, Type or Stamp)
NOTARY'S SIGNATURE
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:
CONSUMER’S CERTIFICATE OF EXEMPTION NUMBER PURCHASER (STATE
AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE
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
FORE
GOING 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
(Name of Deceased) died on
(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
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DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF
MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/
VEHICLE IDENTIFICATION NUMBER AND ODOMETER VERIFICATION
PART A - OWNER’S VEHICLE IDENTIFICATION AFFIDAVIT AND ODOMETER
DECLARATION (Completion of this part requires a physical inspection
of the vehicle by the owner)
AFFIDAVIT: DATE: This is to certify that I, the undersigned, am
the lawful owner of the motor vehicle described on this form and
that I have, on the date entered above, made a physical inspection
of the motor vehicle and have recorded the vehicle identification
number and other identification information and the odometer
reading and certification in the spaces provided on this form.
VEHICLE IDENTIFICATION (MOTOR NUMBER ALL MAKES THROUGH 1954 -
IDENTIFICATION NUMBER 1955 AND LATER)
Vehicle Identification Number Year Make Color Body Previous
State Vehicle Titled In
ODOMETER DECLARATION WARNING: Federal and State law require 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.
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 KNOWLEDGE
THE ODOMETER READING:
1. reflects ACTUAL MILEAGE. 2. is IN EXCESS OF ITS MECHANICAL
LIMITS. 3. is NOT THE ACTUAL MILEAGE.UNDER PENALTY OF PERJURY, I
DECLARE THAT I HAVE READ THE FOREGOING
DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
(Owner’s Signature) (Owner’s Printed Name)
PART B – VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER 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 Florida Notary Public, Licensed Dealer, Police
Officer, or Florida Division of Motorist Services Employee or Tax
Collector Employee. If an out-of-state motor vehicle dealer
verifies the VIN, 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 that the vehicle identification
number on the vehicle to be identical to the vehicle identification
number recorded on this form.
UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE
FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Date: (Seal)
Commissioned Name of Florida Notary: Notary’s Signature: (Print,
Type or Stamp)
If other than a Notary, check the box below that applies, and
sign and complete the corresponding fields. Verified by:
Florida Compliance Examiner/Inspector(DMS/TC Employee) Law
Enforcement Officer Florida Licensed Dealer
Signature: Printed Name:
Florida Compliance Examiner/Inspector Name: Badge or ID #:
Law Enforcement Agency Name: LEO Badge #:
Florida Dealer Name: Florida Dealer #:
◆ NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT ♦
HSMV 82042 (REV. 06/19) www.flhsmv.gov
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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/ APPLICATION FOR DUPLICATE OR LOST IN
TRANSIT/REASSIGNMENT FOR A
MOTOR VEHICLE, MOBILE HOME OR VESSEL TITLE CERTIFICATE 1 TYPE OF
APPLICATION
VEHICLE/VESSEL DUPLICATE: (Fee Required)
VEHICLE/VESSEL LOST IN TRANSIT:
NOTE: No fee required if vehicle application is made within 180
days from last title issuance date and has been lost in
mailing.
LOST STOLEN Damaged (Certificate of Title must be submitted)
NOTE: An indication of lost, stolen or damaged is required.
VEHICLE/VESSEL DUPLICATE WITH TRANSFER: (Both parties must be
present for this transaction)
AND NOTE: When joint ownership, please indicate if “or” or OR
“and” is to be shown on the title when issued. If neither box is
checked, the title will be issued with “and”.
OWNER’S NAME (Last, First, Middle Initial) Owner’s E-Mail
Address PURCHASER’S NAME (Last, First, Middle Initial) Purchaser’s
E-Mail Address
CO-OWNER’S NAME (Last, First, Middle Initial) Co-Owner’s E-Mail
Address CO-PURCHASER’S NAME (Last, First, Middle Initial)
Co-Purchaser’s E-Mail Address
OWNER’S MAILING ADDRESS PURCHASER’S MAILING ADDRESS
CITY STATE ZIP CITY STATE ZIP
CAUTION: IF ADDRESS DIFFERS FROM DMV RECORDS, ADDRESS
VERIFICATION MUST BE SUBMITTED
DATE OF BIRTH PURCHASER’S DL/ID # CO-PURCHASER’S DL/ID#
2 APPLICATION FOR DUPLICATE IS MADE BY:
Owner LIENHOLDER DATE OF LIEN
MOTOR VEHICLE MOBILE HOME OR RECREATIONAL VEHICLE DEALER/
AUCTION LICENSE NUMBER (DEALER/AUCTION LICENSE NUMBER DOES NOT
APPLY TO VESSELS: LIENHOLDER OR DEALER/AUCTION NAME:
ADDRESS: CITY: STATE: ZIP:
3 MOTOR VEHICLE, MOBILE HOME OR VESSEL DESCRIPTION
Vehicle/Vessel Identification Number Make/Manufacturer Year Body
Color License Plate or Vessel Registration Number Florida Title
Number
4 VEHICLE USAGE/BRANDS SHORT TERM LEASE
REPLICA
LONG TERM LEASE
KIT CAR
POLICE VEHICLE
REBUILT
PRIVATE USE
ASSEMBLED FROM PARTS TAXI
FLOOD
MANUFACTURER’S BUY BACK 5 LIENHOLDER INFORMATION
If no lien, Print “None” FEID # DL# & Sex and Date of Birth
DMV Account # Date of Lien Lienholder Name
Lienholder E-Mail Address Lienholder Mailing Address City State
Zip
If Lienholder authorizes the Department to send title to the
owner, check box and countersign.
If this box is not checked, title will be mailed to the first
lienholder. (DOES NOT APPLY TO VESSELS) (Signature of Lienholders
Representative)
6 APPLICATION ATTESTMENT/SIGNATURES AND ODOMETER
DECLARATION/DISCLOSURE WARNING: Federal and state law require that
you state the mileage in connection with an application for
Certificate of Title. 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:
CAUTION: READ CAREFULLY BEFORE YOU CHECK A BOX 1. REFLECTS
ACTUAL MILEAGE. 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. (EXCESS
OF ITS MECHANICAL LIMITS APPLIES TO 5 DIGIT ODOMETERS) 3. IS NOT
THE ACTUAL MILEAGE. WARNING - ODOMETER DISCREPANCY
I CERTIFY THAT THE MOTOR VEHICLE/VESSEL DESCRIBED ABOVE WILL NOT
BE OPERATED ON THE STREETS AND HIGHWAYS/WATERWAYS OF THIS STATE AND
NO FLORIDA LICENSE PLATE HAS BEEN TRANSFERRED TO OR PURCHASED FOR
THIS MOTOR VEHICLE.
I am/we are the owner(s), lienholder(s), and am legally
authorized to apply for and receive the Duplicate Certificate of
Title. I/we further agree to indemnify the Department and defend
the Certificate of Title against all actions or claims by any
person. UNDER PENALTIES OF PERJURY, I/WE DECLARE THAT I/WE HAVE
READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE
TRUE. IF APPLICABLE, I ATTEST TO HAVING Date Sold Selling Price $
ACQUIRED THE MOTOR VEHICLE, MOBILE PURCHASE GIFT INHERITANCE COURT
ORDER HOME OR VESSEL DESCRIBED ABOVE BY:
Signature of Purchaser:
_______________________________________________________________________
Signature of Co-Purchaser:
_____________________________________________________________________
Signature of Seller/ Owner/Lienholder:
__________________________________________________________________
Signature of Co-Owner:
________________________________________________________________________
Printed Name of Purchaser:
_______________________________________________________________________
Printed Name of Co-Purchaser’s:
_____________________________________________________________________
Printed Name of Seller/ Owner/Lienholder:
______________________________________________________________
Printed Name of Co-Owner:
__________________________________________________________________________
7 FOR FLORIDA DMV OR TAX COLLECTOR/LICENSE PLATE AGENCY USE ONLY
Duplicate authorization verification completed
Signature Printed Name County Agency # Date Completed
HSMV 82101 (Rev. 06/11) S www.flhsmv.gov
http://www.flhsmv.gov/offices/�http://www.flhsmv.gov/�http:www.flhsmv.govwww.flhsmv.gov/officeskelseyHighlight
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Instructions for Completing the Form HSMV 82101
Section 1 – Type of Application Vehicle/vessel duplicate – This
box indicates you want to order a replacement title. Also, check
the appropriate box indicating
lost, stolen or damaged. A fee is required for this type of
application.
Vehicle/vessel lost in transit – This box indicates you have
ordered a title and at least 20 days have passed and you have not
received the title. No fee is required if the application is made
within 180 days of the last title issuance which was lost in the
mail. Fees are charged for duplicates or lost in transit requests
after more than 180 days from the previous issuance.
Vehicle/vessel duplicate with transfer – This box should be
checked if you need to order a duplicate title and immediately
transfer it to another owner. Both parties must be present and have
photo identification. A power of attorney may not be used, except
when a total loss from an insurance company is being paid.
Address Change Directions – For an individual owner or
lienholder, if the address differs from the address on the
department’s record, one of the following must be submitted:
o Driver license
o Paid receipt for utility or telephone service
o Proof of homestead exemption
o Paid contract or turn-on order for utility service
o Rental or lease contract agreement
o Current year motor vehicle, mobile home or vessel certificate
of registration
o Copy of insurance policy for motor vehicle, mobile home or
vessel
o Other documentary evidence that provides independent proof of
address change
Section 2 – Application for Duplicate is made by: Check the
appropriate box to indicate who is applying for the duplicate.
Provide name, address and, if you are a dealer, provide your dealer
license number.
Section 3 – Motor Vehicle, Mobile Home or Vessel Description:
Complete all applicable information. The purchaser must provide a
license plate or vehicle registration number if you are requesting
a duplicate with transfer unless the vehicle or vessel will not be
operated on Florida highways or waterways. If the vehicle or vessel
will not be operated on Florida highways or waterways, the box in
section 6 must be checked stating such.
Section 4 – Vehicle Usage/Brands: Check the appropriate box to
indicate how the vehicle will be used. If the vehicle is your
personal vehicle, private use should be checked.
Section 5 – Lienholder Information: If there is no lienholder,
the word none should be indicated in the first box. If a lien is
being added to the record at the time the application is submitted,
all information should be completed.
Section 6 – Application Attestment/Signatures and Odometer
Declarations/Disclosures: Check the box to indicate whether the
vehicle has a five or six-digit odometer and enter the odometer
reading from the vehicle. The vehicle is exempt from the odometer
requirement if it is 10 years old or older.
Enter the odometer reading from the motor vehicle, unless the
motor vehicle is exempt from the odometer requirement. If there is
any reason to doubt the odometer reading does not accurately
reflect “actual” mileage, check the box to indicate “not actual
mileage.” If the vehicle has more than 99,999 on the odometer
reading and it is a 5-digit odometer, the box “in excess of
mechanical limits” must be checked.
If a duplicate with transfer is requested, enter the date of
sale and the selling price. The appropriate box indicating the type
of transaction must also be checked. If the vehicle/vessel will not
be operated on Florida highways or waterways, the box must be
checked.
The appropriate customer(s) must sign and print their names in
the spaces provided.
Fees and Addresses:
Fees are located on our website
http://www3.flhsmv.gov/DMV/Proc/Fees/Fees-01.PDF. Addresses for all
Florida county tax collectors’ offices are located on our website
at: http://www.flhsmv.gov/offices. Some county agencies offer a
fast title service for an additional fee.
The applicant must provide proof of identity (driver license,
identification card, etc.) with their completed application. This
includes proof of identity for any individual signing as an
authorized agent for a company/business, when applicable. This
condition does not apply to a Florida licensed motor vehicle,
mobile home or recreational dealer, a Florida licensed motor
vehicle auction, a licensed insurance company, a lienholder, a
Florida vessel dealer or their authorized agent.
Check your local phone book government pages or visit the
following website for current mailing addresses:
http://www.flhsmv.gov/offices/
THIS FORM IS A COMBINATION OF FORMS HSMV 82101, 82055 AND 87009.
HSMV 82101 (Rev. 06/11) S www.flhsmv.gov
http:www.flhsmv.govhttp://www.flhsmv.gov/officeshttp://www.flhsmv.gov/officeshttp://www3.flhsmv.gov/DMV/Proc/Fees/Fees-01.PDFhttp:www.flhsmv.govhttp://www.flhsmv.gov/officeshttp://www.flhsmv.gov/officeshttp://www3.flhsmv.gov/DMV/Proc/Fees/Fees-01.PDF
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David W. Jordan Lake County Tax Collector
P.O. Box 327 Tavares, FL 32778 352-343-9602 laketax.com
ELECTRONIC TITLE REQUEST AND AUTHORIZATION VIA MAIL
YEAR
VEHICLE OWNER
MAKE VIN #
As the titled owner for the described vehicle, I authorize the
Lake County Tax Collector’s Office to mail the “Electronic Title”
to the following address:
(Printed Name)
(Driver License Number)
(Signature)
(Signature)
UNDER PENALTY OF PERJURY, I CERTIFY THAT I HAVE READ THIS
“ELECTRONIC TITLE REQUEST AND AUTHORIZATION VIA MAIL” DOCUMENT
AND THAT THE FACTS STATED IN IT ARE TRUE.
LCTC Rev. 5/28/2020
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return andpayment methods
DROPBOX:
MAIL:
PAYMENT:
EMAIL:
1800 David Walker Dr., Tavares, FL 32778
1720 North Citrus Blvd., Leesburg, FL 34748
scan for mobile-friendly list of locations on our website at
laketax.com
1505 Hooks St., Clermont, FL 34711
Red dropboxes are located at the front of our offices.
Our office will contact you for payment when your transaction
has been processed.
You may submit your documents via email to
[email protected]
David W. Jordan Lake County Tax Collector P.O. Box 268 Tavares,
FL 32778 352-343-9602 laketax.com
You may mail in this form to: David W. Jordan, Lake County Tax
Collector P.O. Box 268, Tavares, FL 32778
0613_GeneralTitleQuestionspage10613_GeneralTitleQuestionspages1230609_GeneralTitleQuestions0608_GeneralTitleQuestions0608_GeneralTitleQuestions0608_GeneralTitleQuestions0605_GeneralTitleQuestion0528_Title
Questions0528_Title QuestionsGeneral Title
Questions82040.pdfAPPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT
REGISTRATIONOwner Co-OwnerTYPETRANSFER TYPE MAKE OF TRADE INVEHICLE
IDENTIFICATION NUMBER OF TRADE IN
82101.pdfMOTOR VEHICLE, MOBILE HOME OR VESSEL TITLE
CERTIFICATE
ElectronicTitleForm
backpg
Check Box17: OffCheck Box18: OffCheck Box19: OffCheck Box20:
OffCheck Box21: OffCheck Box22: OffCheck Box23: OffCheck Box25:
OffCheck Box26: OffCheck Box27: OffCheck Box28: OffCheck Box29:
OffCheck Box30: OffCheck Box31: OffText33: Text34: Text35: Text36:
Choose One Application Type: Original or Transfer: OffChoose One
Vehicle Type: Motor Vehicle, Mobile Home,or Vessel: OffChoose One
Highway Vehicle: ATV, ROV or MC: OffCustomer Number: Printed
Certificate Title: OffOwner: Are You a Florida Resident:
OffCo-Owner: Are You Florida Resident?: OffOwner: Are You an
Alien?: OffCo-Owner: Are You an Alien?: OffUnit Number: Fleet
Number: And/OR: Offlep: Offtbe: Offwrs: Offocr: OffCounty of
Residence: owner name: owner email: Owner Date of Birth: sex: FL
DL/FEID#: co-owner name: co-owner email: Co-Owner Date of Birth:
sex2: FL DL/FEID#2: owner mailing add: city: st: zip: co-owner
mailing address: city2: st2: zip2: owner physical add: city3: st3:
zip3: mob: Offmhomel add: city4: st4: zip4: mail to cust: name:
email: address:
Customer Date of Birth (if different from owner): Sex_3: FL
DL/FEID#3: city5: st5: zip5: VIN: make: MV-MH-Ves-year: body:
color: FL title number 1: soi: license plate or vessel reg:
number:
wgt: ft: in: bhp/cc: gvw/loc: pgr: Offoth: Offom: Offcmb: Offas:
Offif: Offhb: Offpt: Offab: Offsb: Offpw: Offcn: Offot: Offoth1:
wd: Offal: Offfg: Offslt: Offwf: Offot1: Offoth2: ob: Offsl: Offib:
OffA_2: Offibo: OffOther_3: Offoth3: ga: Offdl: Offel: OffOth4:
Offoth4: ft2: in2: rp: Offdm: Offex: Offcf: Offhl: Offcbc: Offclb:
Offcm: Offcsc: Offcsr: Offcsm: Offgt: Offcc: Offcoy: Offcs: Offco:
Offcsl: Offcommoth: oosreg: #:
cg: Offcdp: Offstate of principple use: lse: Offafp: Offltl:
Offbt: Offreb: Offkit: Offpv: Offgk: Offpu: Offmbb: Offtc: Offrep:
Offfv: Offav: Offilv: Offev: Offcus: Offsr: OffELT: Offfeid:
Offdl#: Offdmv: OffFEID/DL/DMVacct: #:
lienholder's name: lienholder email: lienholder address: city6:
State three: zip6: ila: Offsla: Offgft: Offrepo: Offcd: Offo3:
OffOTS: MO: Day: YEAR1: Odometer Reading: mo2: da2: yr2: ra:
Offiex: Offnot: OffFL reg: #:
date of sale: dealer#: tax: yr: trade-in:
make of trade-in: title#or trade-in: VIN2: Check Box 5 digit:
OffCheck Box 6 digit: OffVIN3: Today's Date: printed name: leoff:
/dealer/agy: name:
badge#: FLDMC/TCname: badge#2: notary name: exemption #: pur:
Offmv2: Offmtm: Offv2: Offsales tax reg: #:
ih: Offg2: Offdd: Offthw: Offet: Offotr: Offother explanation:
i: Offvph: Offoc: Offdcr: Offlt: Offwno: Offwnw: Offoter: Offother
explanation 2: Date of Applicant (Owner) Signature_af_date: Date of
Applicant (Co-Owner) Signature: deceased name: Date of
Death_af_date: t: Offit: Offwa: Offspouse/co-own/heir:
spouse/co-own/heir2: spouse/co-own/heir3: applicant(s) name(s):
DATE: Vehicle Identification Number: Make: Previous State Vehicle
Titled In: Certificate of Title Failure to complete or providing a
false statement may result in fines andor imprisonment: 5 OR: Off6
DIGIT ODOMETER NOW READS: Offundefined_2: undefined_3: undefined_4:
MILES DATE READ: undefined_5: undefined_6: 1 reflects ACTUAL
MILEAGE: Off2 is IN EXCESS OF ITS MECHANICAL LIMITS: Off3 is NOT
THE ACTUAL MILEAGE: OffOwners Printed Name: Date: Commissioned Name
of Florida Notary: If other than a Notary check the box below that
applies and sign and complete the corresponding fields Verified by:
Florida Compliance ExaminerInspectorDMSTC Employee: Law Enforcement
Officer: Florida Compliance ExaminerInspector Name: Badge or ID:
Law Enforcement Agency Name: LEO Badge: Florida Dealer Name:
Florida Dealer: Text1: Text2: VEHICLEVESSEL: OffVEHICLEVESSEL Lost
in Transit: OffLost: OffSTOLEN: Offdamaged title: OffOR: OffAND:
OffOWNERS NAME Last First Middle Initial: Owners EMail Address:
PURCHASERS NAME Last First Middle Initial: Purchasers EMail
Address: COOWNERS NAME Last First Middle Initial: CoOwners EMail
Address: COPURCHASERS NAME Last First Middle Initial: CoPurchasers
EMail Address: OWNERS MAILING ADDRESS: PURCHASERS MAILING ADDRESS:
CITY: STATE: ZIP: CITY_2: STATE_2: ZIP_2: DATE OF BIRTH: PURCHASERS
DLID: COPURCHASERS DLID: owner check mark: OffCheckbox Owner:
LIENHOLDER DATE OF LIEN: License Number: Leinholder or
Dealer/Auction Name: LH address: LH state: LH zip: LH city:
VehicleVessel Identification Number: MakeManufacturer: Year_2:
Year: Body: Color: License Plate or Vessel Registration Number:
Florida Title Number: SHORT TERM LEASE: OffLONG TERM LEASE:
OffPOLICE VEHICLE: OffPRIVATE USE: OffFLOOD: OffTAXI: OffREPLICA:
OffKIT CAR: OffREBUILT: OffASSEMBLED FROM PARTS: OffMANUFACTURERS
BUY BACK: OffIf no lien Print None: FEID#: OffDL sex DOB: OffDMV
account #: OffFEID DL Sex and Date of Birth DMV Account: Date of
Lien: Lienholder Name: Lienholder EMail Address: Lienholder Mailing
Address: City: State: Zip: LH authorizes: OffCheckbox Title Mailed
to Owner: DOES NOT APPLY TO VESSELS: Odometer Number, Ten Thousands
Place: 5 digit odometer: OffOdometer Number, Hundred Thousands
Place: 6 DIGIT ODOMETER: OffOdometer Number, Thousands Place:
Odometer Number, Hundreds Place: Odometer Number, Tens Place:
Odometer Number, Ones Place: month: day: year: Reflects Actual
Miles Checkbox: OffIn Excess of Mechanical Limits: OffNot Actual
Milage: OffReflects Actual Milage: In Excess of Mechanical Limits
Checkbox: Not Actual Milage Checkbox: I certifiy: OffPURCHASE:
OffGIFT: OffINHERITANCE: OffCOURT ORDER: OffDate Sold: Selling
Price: Purchaser: CoPurchaser: OwnerLienholder: CoOwner: printed
name of purchaser: printed name co purchaser: printed seller owner
lienholder: printed name of co owner: Duplicate authorization:
Offverification completed: Printed Name: County: Agency: Date
Completed: Text21: Text22: Text23: Text24: Text25: Text26: Text27:
Text29:
