Form HSMV-81095 "Mh/Rv Comnlaint Registration" - Florida

What Is Form HSMV-81095?

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, 2017;
  • 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;
  • Fill out the form in our online filing application.

Download a printable version of Form HSMV-81095 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 HSMV-81095 "Mh/Rv Comnlaint Registration" - Florida

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MH/RV COMPLAINT REGISTRATION
(Please type or print)
Filed By:
Date of Purchase:
Address:
Date of Delivery
MH:
RV:
NEW:
USED:
Mailing Address:
(CHECK ONE)
(CHECK ONE)
Current License Decal #:
(If different from above)
County of Residence:
Serial #:
Phone
HUD Label #:
#:
(
)
(
)
(Home)
(Work)
(Red/Silver metal tag on rear of unit)
Installer Name:
Has County passed final inspection and/or
Installer License #:
issued a Certificate of Occupancy? YES / NO
Date Installed:
Label #:
Date of issue:
(Circle One)
DEALER INFORMATION
MANUFACTURER INFORMATION
(Name of Dealer)
(Name of Manufacturer)
(
(Address of Dealer)
Address of Manufacturer)
(City / State / Zip)
(City / State / Zip)
(Telephone Number)
(Telephone Number)
Have you contacted the Dealer in writing concerning your problems?
Have you contacted the Manufacturer in writing concerning
Yes / No
Please Give Dates and Persons Contacted.
your problems? Yes / No .
Please give dates and persons
:
Contacted
Do you object to Dealer/Installer being present? Yes
No
Do you object to Mfg. being present? Yes
No
NOTE: If there are contractual problems, please attach copies of all supporting documents,
NATURE OF COMPLAINT
including purchase agreement, contract, etc.
(Use reverse side of this form if additional space is needed)
If your home is not located in a park, please provide directions to your homefrom a major highway in your area
MAIL TO: Manufactured Housing Section
Division of Motorist Services
5701 E. Hillsborough Avenue
(Signature of Complainant)
(Date Signed)
Net Park Suite 2228
Tampa, Florida 33610
Ph: 813/302-5036 Fax: 813/612-7131
OFFICE USE ONLY
TBR NJ
Please allow 2 to 4 weeks processing time, depending on office
SPI R
workload, for a response to your complaint.
(Inspector)
HSMV-81095 (Rev. 04/17)
Page 1 of 2
MH/RV COMPLAINT REGISTRATION
(Please type or print)
Filed By:
Date of Purchase:
Address:
Date of Delivery
MH:
RV:
NEW:
USED:
Mailing Address:
(CHECK ONE)
(CHECK ONE)
Current License Decal #:
(If different from above)
County of Residence:
Serial #:
Phone
HUD Label #:
#:
(
)
(
)
(Home)
(Work)
(Red/Silver metal tag on rear of unit)
Installer Name:
Has County passed final inspection and/or
Installer License #:
issued a Certificate of Occupancy? YES / NO
Date Installed:
Label #:
Date of issue:
(Circle One)
DEALER INFORMATION
MANUFACTURER INFORMATION
(Name of Dealer)
(Name of Manufacturer)
(
(Address of Dealer)
Address of Manufacturer)
(City / State / Zip)
(City / State / Zip)
(Telephone Number)
(Telephone Number)
Have you contacted the Dealer in writing concerning your problems?
Have you contacted the Manufacturer in writing concerning
Yes / No
Please Give Dates and Persons Contacted.
your problems? Yes / No .
Please give dates and persons
:
Contacted
Do you object to Dealer/Installer being present? Yes
No
Do you object to Mfg. being present? Yes
No
NOTE: If there are contractual problems, please attach copies of all supporting documents,
NATURE OF COMPLAINT
including purchase agreement, contract, etc.
(Use reverse side of this form if additional space is needed)
If your home is not located in a park, please provide directions to your homefrom a major highway in your area
MAIL TO: Manufactured Housing Section
Division of Motorist Services
5701 E. Hillsborough Avenue
(Signature of Complainant)
(Date Signed)
Net Park Suite 2228
Tampa, Florida 33610
Ph: 813/302-5036 Fax: 813/612-7131
OFFICE USE ONLY
TBR NJ
Please allow 2 to 4 weeks processing time, depending on office
SPI R
workload, for a response to your complaint.
(Inspector)
HSMV-81095 (Rev. 04/17)
Page 1 of 2
Directions to the Mobile Home
Location:
Directions must start from a known specific point so that the compliance examiner may proceed
directly to the location of your home.
In the space below, draw a sketch using highway and road numbers, names and other landmarks or point of
location indicating exactly how to find this property.
Page 2 of 2
Page of 2