Form HSMV84256 "Application for a License as a Motor Vehicle or Recreational Vehicle Manufacturer, Importer, or Distributor or a Mobile Home Manufacturer" - Florida

What Is Form HSMV84256?

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 August 1, 2018;
  • 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 HSMV84256 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 HSMV84256 "Application for a License as a Motor Vehicle or Recreational Vehicle Manufacturer, Importer, or Distributor or a Mobile Home Manufacturer" - Florida

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
DEALER LICENSE SECTION
2900 Apalachee Parkway, Room A312 – MS 65,
Tallahassee, Florida 32399
APPLICATION FOR A LICENSE AS A MOTOR VEHICLE OR RECREATIONAL VEHICLE
MANUFACTURER, IMPORTER, OR DISTRIBUTOR OR A MOBILE HOME MANUFACTURER
OFFICE USE ONLY
Do not use white out or correction tape on this application
Entered By: _______
1. Pursuant to Sections 320.60-320.70, 320.3203, or 320.8225, Florida Statutes, I hereby make
Approved By: ______
application and submit the required documentation for a license, or modifications as:
MD Motor Vehicle Distributor – 320.60, F.S.
Original Application
LICENSE NUMBER
MI
Motor Vehicle Importer – 320.60, F.S.
Modification:
MV Motor Vehicle Manufacturer – 320.60, F.S.
Corporate Officer Update
ISSUE DATE
MH Mobile Home Manufacturer – 320.8225, F.S.
Name Change
MR Recreational Vehicle Manufacturer – 320.8225, F.S.
Change of Location
RD
Recreational Vehicle Distributor – 320.8225, F.S.
Postal Update
AMOUNT
RI
Recreational Vehicle Importer – 320.8225, F.S.
Change of Mailing Address
CHECK NUMBER
Current or Last License Number:
Licensee Name:
CRS PAYMENT
NUMBER
Fictitious (DBA) Name (s):
Physical Address:
Street Address
DATE
APPLICATION WAS
City
State
Zip Code
RECEIVED IN
Mailing Address:
DEALER LICENSE
Enter Mailing Address Even if Same as Physical Address (Street or Post Office Box)
SECTION
City
State
Zip Code
Business Telephone Number: (
)
Cell Number: (
)
DATE
Business Email Address:
Fax Number: (
)
APPLICATION WAS
COMPLETED
Federal Employer Identification Number:
Proof of Identification#/DL#, If Sole Proprietor or Partnership :
FRVIS CUSTOMER
Please see instruction guide for acceptable proof of identification
NUMBER
2. Line make(s) of vehicle(s) and/or unit(s) manufactured, distributed, or imported:
Division of
Motorcycles greater than 50cc:
Motorcycles 50cc or less:
Corporations
Active
Low Speed Vehicles
Tri-Vehicle
Inactive
3.
Sole Proprietor
Corporation
Limited Liability Company/Partnership (LLC/LLP)
Limited Liability Limited Partnership (LLLP)
Partnership
Limited Partnership (LP)
A. SOLE OWNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (If other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
B. PARTNERS:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (If other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
HSMV 84256 (Rev. 08/18)
Please mail the completed application and required documents to: The Dealer License
Section, 2900 Apalachee Parkway, Room A312 – MS 65, Tallahassee, Florida 32399.
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
DEALER LICENSE SECTION
2900 Apalachee Parkway, Room A312 – MS 65,
Tallahassee, Florida 32399
APPLICATION FOR A LICENSE AS A MOTOR VEHICLE OR RECREATIONAL VEHICLE
MANUFACTURER, IMPORTER, OR DISTRIBUTOR OR A MOBILE HOME MANUFACTURER
OFFICE USE ONLY
Do not use white out or correction tape on this application
Entered By: _______
1. Pursuant to Sections 320.60-320.70, 320.3203, or 320.8225, Florida Statutes, I hereby make
Approved By: ______
application and submit the required documentation for a license, or modifications as:
MD Motor Vehicle Distributor – 320.60, F.S.
Original Application
LICENSE NUMBER
MI
Motor Vehicle Importer – 320.60, F.S.
Modification:
MV Motor Vehicle Manufacturer – 320.60, F.S.
Corporate Officer Update
ISSUE DATE
MH Mobile Home Manufacturer – 320.8225, F.S.
Name Change
MR Recreational Vehicle Manufacturer – 320.8225, F.S.
Change of Location
RD
Recreational Vehicle Distributor – 320.8225, F.S.
Postal Update
AMOUNT
RI
Recreational Vehicle Importer – 320.8225, F.S.
Change of Mailing Address
CHECK NUMBER
Current or Last License Number:
Licensee Name:
CRS PAYMENT
NUMBER
Fictitious (DBA) Name (s):
Physical Address:
Street Address
DATE
APPLICATION WAS
City
State
Zip Code
RECEIVED IN
Mailing Address:
DEALER LICENSE
Enter Mailing Address Even if Same as Physical Address (Street or Post Office Box)
SECTION
City
State
Zip Code
Business Telephone Number: (
)
Cell Number: (
)
DATE
Business Email Address:
Fax Number: (
)
APPLICATION WAS
COMPLETED
Federal Employer Identification Number:
Proof of Identification#/DL#, If Sole Proprietor or Partnership :
FRVIS CUSTOMER
Please see instruction guide for acceptable proof of identification
NUMBER
2. Line make(s) of vehicle(s) and/or unit(s) manufactured, distributed, or imported:
Division of
Motorcycles greater than 50cc:
Motorcycles 50cc or less:
Corporations
Active
Low Speed Vehicles
Tri-Vehicle
Inactive
3.
Sole Proprietor
Corporation
Limited Liability Company/Partnership (LLC/LLP)
Limited Liability Limited Partnership (LLLP)
Partnership
Limited Partnership (LP)
A. SOLE OWNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (If other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
B. PARTNERS:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (If other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
HSMV 84256 (Rev. 08/18)
Please mail the completed application and required documents to: The Dealer License
Section, 2900 Apalachee Parkway, Room A312 – MS 65, Tallahassee, Florida 32399.
APPLICATION FOR A LICENSE AS A MOTOR VEHICLE OR RECREATIONAL VEHICLE MANUFACTURER, IMPORTER, DISTRIBUTOR,
OR MOBILE HOME MANUFACTURER
PARTNERS continued:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
C. CORPORATE/LLC/LP/LLP/LLLP:
Corporate Name
Corporate Headquarters Business Address
City
State
Zip Code
Date Corporation Registered with Florida Secretary of State
State or County of Incorporation
PRESIDENT/MGR/MEMBER/PARTNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
VICE PRES /MGR/MEMBER/PARTNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
SECRETARY/MGR/MEMBER/PARTNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
TREASURER/MGR/MEMBER/PARTNER:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
DIRECTOR:
Last Name
First Name
Middle Initial
Date of Birth
FL DL/ID# (if other proof of ID is used, attach copy)
Phone Number w/ Area Code
(FRVIS Customer Number – Office Use Only)
Residence Address
City
State
Zip Code
Please attach the following items to application:
♦ A current financial statement (Motor Vehicle or Recreational Vehicle
♦ Copies of all applicable preparation and delivery charge agreements;
♦ Copies of all applicable warranty labor rates and parts agreements;
Manufacturers, Distributors, and Importers or Mobile Home
Manufacturers);
♦ Articles of Incorporation or Articles of Organization and Operating
♦ Surety bond or irrevocable letter of credit (Mobile Home
Agreement, or Partnership Agreement;
Manufacturers);
♦ Photos of the vehicles, with specifications;
♦ Surety bond (Recreational Vehicle Manufacturers, Distributors, or
♦ Copy of fictitious name registered with Secretary of State;
Importers);
♦ Copy of certification from the Division of Corporations showing current
♦ A copy of the product warranty;
registration of business to conduct business in the State of Florida (on-
♦ A list of authorized Florida dealers;
line access at www.sunbiz.org); and
♦ License Fee of $300 for Motor Vehicle Manufacturer, Importer, or
♦ Manufacturer’s Statement of Origin as per State of Florida requirements.
Distributor and $340 for Mobile Home Manufacturer and Recreational
Vehicle Manufacturer, Importer, or Distributor. Make checks payable
to DHSMV;
Please refer to the attached checklist for further requirements.
Under penalty of perjury, I do swear and affirm that the information contained in this application is true and correct. I further affirm that I am
authorized to bind the application with my signature.
Original Signature of Officer
Printed Name of Officer
Title
Please mail the completed application and required documents to: The Dealer License
HSMV 84256 (Rev. 08/18)
Section, 2900 Apalachee Parkway, Room A312 – MS 65, Tallahassee, Florida 32399.
RE:
Licensing Requirements for Manufacturer, Distributor, or Importer License
The enclosed packet contains forms necessary to make application for either of the above referenced
licenses. When you have completed both sides of the application and have provided supporting documents,
listed on the enclosed check list, mail them to the Division of Motorist Services with a check in the appropriate
amount. For a Motor Vehicle Manufacturer, Importer, or Distributor license, please submit a check in the
amount of $300. And for a Mobile Home Manufacturer or Recreational Vehicle Manufacturer, Distributor,
Importer or a Van Converter license, please submit a check in the amount of $340. Please make the check
payable to the Department of Highway Safety and Motor Vehicles (DHSMV).
Mail applications to the following address:
Division of Motorist Services
Neil Kirkman Building
Room A312, MS #65
2900 Apalachee Parkway
Tallahassee, Florida 32399-0635
If you have any questions or need additional information, please contact our office at 850-617-3003
(press 1).
Enclosures
Instruction Guide
HSMV 84256 Application Form
Acceptable Proof of Identification for Sole Proprietor or Partnership includes:
 A Florida driver license or identification card;
 An out of state driver license or identification card;
 A US passport;
 A Canadian driver license, identification card, or passport;
 A driver license or identification card from any US Territory (American Samoa, Guam,
Marianas, Puerto Rico, and the US Virgin Islands); and
 An out of country passport.
A copy of the proof of identification must be submitted with your renewal form to the
Department unless the proof of identification submitted is a Florida driver license or
identification card.
Division of Motorist Services, Bureau of Dealer Services, Dealer Licensing Section Neil Kirkman
Building, Room A312, MS-65, 2900 Apalachee Parkway
Tallahassee, Florida 32399-0635, 850-617-3003 (press 1)
http://www.flhsmv.gov
Check List
Manufacturer, Importer, or Distributor of Motorcycles
With an Engine Displacement of 50cc or Less
□ 1.
Complete both sides of application form HSMV 84256.
□ 2.
Distributor or Importer applicants must provide copies of an agreement between the manufacturer and themselves
authorizing the applicant to distribute or import the manufacturer's vehicles. The agreement must be dated and
signed by both parties.
□ 3.
A current financial statement must be included with application.
□ 4.
A copy of the product warranty in any way connected with the motor vehicle or any component thereof must be
submitted with application.
□ 5.
Federal Employer Identification Number must be submitted with application.
□ 6.
For corporations, a copy of their Articles of Incorporation as filed with the Division of Corporations in the office
of Secretary of State must be submitted with the application. A foreign corporation (i.e., one from out-of-state)
must also submit a copy of its Articles of Incorporation as filed with Secretary of State or a copy of its Articles of
Incorporation as filed in their home state; Limited Liability Companies must submit a copy of their Articles of
Organization and Operating Agreement with the application; or Partnerships must submit a copy of their
partnership agreement with the application.
□ 7.
Proof of registration with the Florida Secretary of State, Division of Corporations to conduct business in Florida,
must be provided with your application. You may find information about this process on-line from the Division
of Corporations at www.sunbiz.org.
□ 8.
Proof of registration of fictitious name(s) with the Florida Secretary of State, Division of Corporations (on-line
access at www.sunbiz.org).
□ 9.
A check payable to the Department of Highway Safety and Motor Vehicles (DHSMV) in the amount of $300
must be submitted with application.
□ 10. A photo of the vehicle(s) being manufactured, distributed or imported; or a brochure with pictures and
specifications of the vehicle(s) must be included with application.
□ 11. An affidavit stating that the line-make(s) meets all certification requirements set forth by the U.S. Department of
Transportation must be submitted with application.
□ 12. World Manufacturing Identifier (WMI) – Further information regarding registration as a manufacturer, importer
or distributor may be obtained on-line from the National Highway Traffic Safety Administration at
www.nhtsa.gov. Before a manufacturer can offer motorcycles, with an engine displacement of 50cc's or less, for
sale in the United States, a manufacturer must designate an agent for service of process in this country (Title 49
CFR 551.45) (Procedural Rules). It must also apply for its own world manufacturing identifier (WMI),
comprising the first three characters of the vehicle identification number which must be affixed to the vehicles it
manufactures. In addition:
Title 49 CFR part 565 (Vehicle Identification Number Requirements),
Title 49 CFR part 566 (Manufacturer Identification) and
Title 49 CFR part 567 (Certification), the certification label on the vehicle constitutes the manufacturer's
certification that the motor vehicle "conforms to all applicable Federal Motor Vehicle Safety Standards in
effect on the date of manufacture." Copies of any letters from NHTSA verifying that you have met these
requirements must be provided to the Department with your application.
Additional information on other requirements for new vehicle manufacturers can be obtained from NHTSA by
phone at 202-366-5302, or by fax 202-493-0073, or on-line at www.nhtsa.gov.
□ 13. Once the Department receives your completed application and required documents listed above, the Department
will request the National Crime Information Center (NCIC) to assign you a "line-make" which will be reflected
on your Manufacturer's Statement of Origin (MSO) or your Manufacturer's Certificate of Origin (MCO). Once
the line-make has been assigned by NCIC, the Department will fax or email you a sample of the MSO. Please
provide the Department an original sample of your MSO or MCO based on the faxed or emailed sample. You
may stamp "VOID" or "SPECIMEN" across the front of the MSO. The MSO or MCO must be printed on secure
paper in accordance with the attached specification set forth by the State of Florida. If the vehicle is an electric
motorcycle the MSO or MCO must state the displacement of engine in Watts. If the vehicle is a gas powered
motorcycle the displacement of the engine must be stated in cubic centimeters. Please Note: Do not send the
MSO or MCO with your application until your line-make has been assigned and the Department has faxed
or emailed you a sample.
NOTE: Please submit the documents in the order requested on this checklist.