Form HSMV73644 "Refund Request" - Florida

What Is Form HSMV73644?

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 July 1, 2011;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HSMV73644 by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

ADVERTISEMENT
ADVERTISEMENT

Download Form HSMV73644 "Refund Request" - Florida

Download PDF

Fill PDF online

Rate (4.5 / 5) 55 votes
Division of Motorist Services
Refund Request
A refund is requested for the Following (Check proper box/boxes)
License Fee
Examination Fee
Service Fee
FR Re-fee
ID Card Fee
Other ________________________
List All Applications Pertaining to Refund Below:
Date (s) Applied
__________
Office # __________
Audit # (s) __________
Fees Paid __________
____
______
__________
__________
__________
____
______
__________
__________
__________
Justification for Refund (Explain Fully):
Name
Address
Driver License Number
Date of Birth
Total Refund
Office ID
Examiner ID
Date
Customer’s Signature
Instructions: Please complete, print and sign this form.
Mail form to:
Division of Motorist Services
P.O. Box 5775
Tallahassee, FL 32314-5775
HSMV 73644 (Rev 07/11)
Division of Motorist Services
Refund Request
A refund is requested for the Following (Check proper box/boxes)
License Fee
Examination Fee
Service Fee
FR Re-fee
ID Card Fee
Other ________________________
List All Applications Pertaining to Refund Below:
Date (s) Applied
__________
Office # __________
Audit # (s) __________
Fees Paid __________
____
______
__________
__________
__________
____
______
__________
__________
__________
Justification for Refund (Explain Fully):
Name
Address
Driver License Number
Date of Birth
Total Refund
Office ID
Examiner ID
Date
Customer’s Signature
Instructions: Please complete, print and sign this form.
Mail form to:
Division of Motorist Services
P.O. Box 5775
Tallahassee, FL 32314-5775
HSMV 73644 (Rev 07/11)