Form HSMV82083 S "Application to Become an Authorized Electronic Filing System Agent / Change of Certified Service Provider" - Florida

Form HSMV82083 S is a Florida Department of Highway Safety and Motor Vehicles form also known as the "Form Hsmv82083 S "application To Become An Authorized Electronic Filing System Agent / Change Of Certified Service Provider" - Florida". The latest edition of the form was released in August 1, 2011 and is available for digital filing.

Download a PDF version of the Form HSMV82083 S down below or find it on Florida Department of Highway Safety and Motor Vehicles Forms website.

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Download Form HSMV82083 S "Application to Become an Authorized Electronic Filing System Agent / Change of Certified Service Provider" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES
2900 APALACHEE PARKWAY, NEIL KIRKMAN BUILDING - TALLAHASSEE, FL 32399-0610
APPLICATION TO BECOME AN AUTHORIZED ELECTRONIC FILING SYSTEM AGENT /
CHANGE OF CERTIFIED SERVICE PROVIDER
Check One:
DMS USE ONLY
 Pursuant to section 320.03(10), Florida Statutes, I hereby make application to become
authorized to process title and registration transactions using the Electronic Filing System.
 I hereby request to change Certified Service Providers.
Name of Entity / Business:
Mailing address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Dealer License Number:
If licensed as a motor vehicle, mobile home or recreational vehicle dealer.
County where physically located:
Appointing County where agent will process transactions:
If appointing county is different than where agent is physically located signature of the appointing Tax Collector is required.
_________________________________________
Signature of Appointing Tax Collector
Business Telephone Number:
Cell Number:
E-mail Address:
Owner / Partner / Principal Name(s):
1.
2.
3.
Certified Service Provider: (enter name of CSP)
Applicant must have entered into a contract with a certified service provider prior to applying to become an EFS agent.
If applicant is changing Certified Service Providers all pending or suspended transactions with the previous provider must be complete,
a contract signed with the new certified service provider and notification to the state prior to using the new provider’s services.
All principals and prospective users have undergone a criminal background check
Indicia shall be secure and in a locked area during non-business hours or when not being used.
I certify that the entity above meets the requirements to become an authorized electronic filing system (EFS) agent.
The entity will abide by all laws, rules, procedures and contractual obligations required as an EFS agent. All principals and authorized
users have undergone a criminal background check prior to having access to the EFS and indicia as provided by the Tax Collector. All
indicia will be secure and in a locked area during non-business hours or during non-use and I understand that I am responsible for any
unaccounted inventory. I further certify that all applicable inquiry fees will be paid to the state and that disclosures for EFS fees as
required by rule will be made to prospective buyers. I will ensure that all title and registration transactions are done in accordance with
laws and Department procedure. I further certify that state and county fees collected will be remitted electronically in accordance with
state law. I understand that failure to comply with any laws, rules or contractual terms shall be grounds for the Department to revoke
my authorization to use the EFS.
The applicant agrees to comply with section 119.0712 (2), Florida Statutes, and the Federal Driver’s Privacy Protection Act (18 U. S. C.
§ 2721 et seq.). The applicant agrees that all personal information governed by these statutes will be used or redisclosed by the
applicant only as permitted by these statutes. Any use or redisclosure of such personal information by the applicant except as
permitted by these statutes will result in DHSMV revoking applicant’s ability to use the system.
Under penalty of perjury, I do swear and affirm that the information contained in this application is true and correct and that applicant
will abide by all laws of Florida and all applicable rules, policies and procedures of the Department of Highway Safety and Motor
Vehicles.
Signature of owner or principal: _______________________________________________ Date: __________________
Rules 15C-18.004(1)(d). 15C-18.006(4), FAC
HSMV 82083 S (Rev. 08/11)
 
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES
2900 APALACHEE PARKWAY, NEIL KIRKMAN BUILDING - TALLAHASSEE, FL 32399-0610
APPLICATION TO BECOME AN AUTHORIZED ELECTRONIC FILING SYSTEM AGENT /
CHANGE OF CERTIFIED SERVICE PROVIDER
Check One:
DMS USE ONLY
 Pursuant to section 320.03(10), Florida Statutes, I hereby make application to become
authorized to process title and registration transactions using the Electronic Filing System.
 I hereby request to change Certified Service Providers.
Name of Entity / Business:
Mailing address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Dealer License Number:
If licensed as a motor vehicle, mobile home or recreational vehicle dealer.
County where physically located:
Appointing County where agent will process transactions:
If appointing county is different than where agent is physically located signature of the appointing Tax Collector is required.
_________________________________________
Signature of Appointing Tax Collector
Business Telephone Number:
Cell Number:
E-mail Address:
Owner / Partner / Principal Name(s):
1.
2.
3.
Certified Service Provider: (enter name of CSP)
Applicant must have entered into a contract with a certified service provider prior to applying to become an EFS agent.
If applicant is changing Certified Service Providers all pending or suspended transactions with the previous provider must be complete,
a contract signed with the new certified service provider and notification to the state prior to using the new provider’s services.
All principals and prospective users have undergone a criminal background check
Indicia shall be secure and in a locked area during non-business hours or when not being used.
I certify that the entity above meets the requirements to become an authorized electronic filing system (EFS) agent.
The entity will abide by all laws, rules, procedures and contractual obligations required as an EFS agent. All principals and authorized
users have undergone a criminal background check prior to having access to the EFS and indicia as provided by the Tax Collector. All
indicia will be secure and in a locked area during non-business hours or during non-use and I understand that I am responsible for any
unaccounted inventory. I further certify that all applicable inquiry fees will be paid to the state and that disclosures for EFS fees as
required by rule will be made to prospective buyers. I will ensure that all title and registration transactions are done in accordance with
laws and Department procedure. I further certify that state and county fees collected will be remitted electronically in accordance with
state law. I understand that failure to comply with any laws, rules or contractual terms shall be grounds for the Department to revoke
my authorization to use the EFS.
The applicant agrees to comply with section 119.0712 (2), Florida Statutes, and the Federal Driver’s Privacy Protection Act (18 U. S. C.
§ 2721 et seq.). The applicant agrees that all personal information governed by these statutes will be used or redisclosed by the
applicant only as permitted by these statutes. Any use or redisclosure of such personal information by the applicant except as
permitted by these statutes will result in DHSMV revoking applicant’s ability to use the system.
Under penalty of perjury, I do swear and affirm that the information contained in this application is true and correct and that applicant
will abide by all laws of Florida and all applicable rules, policies and procedures of the Department of Highway Safety and Motor
Vehicles.
Signature of owner or principal: _______________________________________________ Date: __________________
Rules 15C-18.004(1)(d). 15C-18.006(4), FAC
HSMV 82083 S (Rev. 08/11)
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