DATE
MOBILE HOME INSTALLATION DECAL ORDER FORM
TO:
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
2900 APALACHEE PARKWAY, MAIL STOP 66
TALLAHASSEE, FLORIDA 32399-0640
is Enclosed
Fee of $
APPLICATION IS HEREBY MADE FOR:
# Mobile Home Installation Decals ……………………………………. $10.00
(minimum of five)
Please make check payable to DHSMV
NAME
ADDRESS
CITY/STATE
PHONE #
INSTALLER LICENSE # (DIH OR IH)
DEALER/MANUFACTURER LICENSE # (DH OR MH)
I hereby certify that these decals will be applied as required in section 320.8249
Florida Statutes, and understand these decals are non-transferable.
st
1
SIGNATURE
Licensed Mobile Home Dealer, Installer or Manufacturer
nd
2
SIGNATURE
Who Attended the 8-hour Training Class & Passed Exam
(Only required if different from 1
st
Signature)
DMV USE ONLY
NUMBER
THROUGH
ASSIGNED BY
DATE
DO NOT SEPARATE ORIGINAL AND COPY
HSMV-81404 (Rev. 01/11)
DATE
MOBILE HOME INSTALLATION DECAL ORDER FORM
TO:
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
2900 APALACHEE PARKWAY, MAIL STOP 66
TALLAHASSEE, FLORIDA 32399-0640
is Enclosed
Fee of $
APPLICATION IS HEREBY MADE FOR:
# Mobile Home Installation Decals ……………………………………. $10.00
(minimum of five)
Please make check payable to DHSMV
NAME
ADDRESS
CITY/STATE
PHONE #
INSTALLER LICENSE # (DIH OR IH)
DEALER/MANUFACTURER LICENSE # (DH OR MH)
I hereby certify that these decals will be applied as required in section 320.8249
Florida Statutes, and understand these decals are non-transferable.
st
1
SIGNATURE
Licensed Mobile Home Dealer, Installer or Manufacturer
nd
2
SIGNATURE
Who Attended the 8-hour Training Class & Passed Exam
(Only required if different from 1
st
Signature)
DMV USE ONLY
NUMBER
THROUGH
ASSIGNED BY
DATE
DO NOT SEPARATE ORIGINAL AND COPY
HSMV-81404 (Rev. 01/11)
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