Form HSMV72077 "Release From Incarceration Form" - Florida

What Is Form HSMV72077?

This is a legal form that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2016;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form HSMV72077 by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download Form HSMV72077 "Release From Incarceration Form" - Florida

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Division of Motorist Services
Terry L. Rhodes
2900 Apalachee Parkway
Executive Director
Tallahassee, Florida 32399
Robert Kynoch
www.flhsmv.gov
Division Director
Release From Incarceration Form
Name:
Street Address:
Sex:
Date of Birth:
Driver License Number:
Violation/Offense:
Violation/Offense Date:
Conviction Date:
Incarceration Date:
(Must be on or after conviction date)
Release Date:
(Must be on or after conviction date or incarceration date and/or credit for time served)
Agency:
Address of Agency:
Name and Title of Person Signing
Release:
Signature of Person Signing
Release:
Telephone Number of Person Signing:
Release:
Name of Person in Charge of Correctional Facility:
Telephone Number of Person in Charge of Facility:
(For D.H.S.M.V. Use Only)
Date Mailed or Faxed to D.H.S.M.V:
Examiner’s Name:
Office Number:
Department of Highway Safety and Motor Vehicles
Neil Kirkman Building, Room A325, Mail Stop 87
2900 Apalachee Parkway
Tallahassee, Florida 32399-0580
Fax Number (850) 617-3939
HSMV 72077 (Rev 04/16)
Division of Motorist Services
Terry L. Rhodes
2900 Apalachee Parkway
Executive Director
Tallahassee, Florida 32399
Robert Kynoch
www.flhsmv.gov
Division Director
Release From Incarceration Form
Name:
Street Address:
Sex:
Date of Birth:
Driver License Number:
Violation/Offense:
Violation/Offense Date:
Conviction Date:
Incarceration Date:
(Must be on or after conviction date)
Release Date:
(Must be on or after conviction date or incarceration date and/or credit for time served)
Agency:
Address of Agency:
Name and Title of Person Signing
Release:
Signature of Person Signing
Release:
Telephone Number of Person Signing:
Release:
Name of Person in Charge of Correctional Facility:
Telephone Number of Person in Charge of Facility:
(For D.H.S.M.V. Use Only)
Date Mailed or Faxed to D.H.S.M.V:
Examiner’s Name:
Office Number:
Department of Highway Safety and Motor Vehicles
Neil Kirkman Building, Room A325, Mail Stop 87
2900 Apalachee Parkway
Tallahassee, Florida 32399-0580
Fax Number (850) 617-3939
HSMV 72077 (Rev 04/16)