Form HSMV82040 "Application for Certificate of Title With/Without Registration" - Florida

What Is Form HSMV82040?

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 November 1, 2015;
  • 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 fillable version of Form HSMV82040 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 HSMV82040 "Application for Certificate of Title With/Without Registration" - Florida

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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/
CHECK APPLICATION TYPE:
ORIGINAL
TRANSFER
VEHICLE TYPE:
MOTOR VEHICLE
MOBILE HOME
VESSEL
OFF-HIGHWAY VEHICLE:
ATV
ROV
MC
1
OWNER / APPLICANT INFORMATION
Customer Number
Check this box if you are requesting
Owner
Co-Owner
Unit Number
Fleet Number
the certificate of title to be printed.
Are you a Florida resident?
yes
no
yes
no
Are you an alien?
yes
no
yes
no
Iiiiiii
OR
AND NOTE: When joint ownership, please indicate if “or” or “and” is to be shown on title when issued. If neither box is checked, the title will be issued with "and."
If applicable:
Life Estate/Remainder Person
Tenancy By the Entirety
With Rights of Survivorship
Owner's County of Residence: _____________________________________
Owner’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name)
Owner’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Co-Owner/Lessee’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name)
Co-Owner’s/Lessee’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Owner’s Mailing Address (Mandatory unless a member of the Military)
City
State
Zip
Co-Owner’s/Lessee’s Mailing Address (Mandatory unless a member of the Military)
State
Zip
City
Owner’s/Lessee’s Physical Street Address in Florida (Mandatory unless a member of the Military)
State
Zip
City
Check if in a mobile home rental park with 10 or more lots.
Mobile Home Physical Address
(if applicable)
State
Zip
City
\\
Mail To Customer Name (If different From Above Owner)
Mail To Customer’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Mail To Customer Address (If different From Above Mailing Address)
City
State
Zip
2
MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTION
Vehicle/Vessel Identification Number
Make/Manufacturer
Year
Body
Color
Florida Title Number
License Plate or Vessel Registration Number
Previous State of Issue
Weight
Length
BHP/CC
GVW/LOC
VAN USE, IF APPLICABLE
Ft.
In.
PASSENGER
OTHER
TYPE
HULL MATERIAL
PROPULSION
FUEL
*DRAFT OF VESSEL
(The depth of water a
Open Motorboat
Houseboat
Personal Watercraft
Wood
Aluminum
Outboard
Sail
Gas
vessel draws)
Cabin Motorboat
Pontoon
Canoe
Fiberglass
Steel
Inboard
Air Propelled
Diesel
_________
Auxiliary Sailboat
Airboat
Other
Wood/Fiberglass
Inboard/Outboard
Electric
______
______
FT.
IN.
Inflatable
Sailboat
Other______________________
Other__________________________
Other_________________
Specify
*
For all vessels 26’ or more in
Specify
Specify
Specify
length and all sailboats
USE OF VESSEL
PREVIOUS
OUT-OF-STATE
Recreational (Pleasure)
Commercial Blue Crab
Commercial Stone Crab
Government
Commercial Sponge
REGISTRATION NUMBER:
Dealer/Manuf.
Commercial Fish
Commercial Live Bait
Commercial Shrimp Recip.
Commercial Charter
Commercial Other ______________
Exempt
Hire (Livery)
Commercial Mackerel
Commercial Shrimp Non-Recip.
Commercial Oyster
Commercial Spiney Lobster
Previously Federally Documented Vessel, Attach Copy of:
State of Principal Use
U.S. Coast Guard Release From Documentation Form; or
Copy of Canceled Documentation Papers
3
BRANDS, USAGE AND TYPE (Check Applicable Boxes)
SHORT TERM LEASE
LONG TERM LEASE
REBUILT
POLICE VEHICLE
PRIVATE USE
TAXI CAB
FLOOD
ILEV
CUSTOM
ASSEMBLED FROM PARTS
BONDED TITLE
KIT CAR
GLIDER KIT
MANUF. BUY BACK
REPLICA
AUTONOMOUS
ELECTRIC
STREET ROD
4
LIENHOLDER INFORMATION
Date of Lien
Lienholder's Name
CHECK
FEID #
DL # and Sex and Date of Birth
DMV Account #
IF ELT
CUSTOMER
Lienholder’s Email Address
Lienholder's Address
City
State
Zip
If Lienholder authorizes the Department to send the motor vehicle or mobile home title to the owner, check box and countersign: ________________________________________________________________________
(Does not apply to vessels). If box is not checked, title will be mailed to the first lienholder.
(Signature of Lienholder’s Representative)
5
TRANSFER TYPE
IF OWNERSHIP HAS TRANSFERRED, HOW AND WHEN WAS THE VEHICLE, MOBILE HOME, OR VESSEL ACQUIRED?
DATE ACQUIRED
SALE
GIFT
REPOSSESSION
COURT ORDER
OTHER (SPECIFY) __________________________________________
_________/___________/______________
6
ODOMETER DECLARATION
WARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing a false statement may result in fines or imprisonment.
,
.
I/WE STATE THAT THIS
5 OR
6 DIGIT ODOMETER NOW READS
MILES, DATE READ _____ /_____ / ________ AND I/WE HEREBY CERTIFY
XX
(NO TENTHS)
THAT TO THE BEST OF MY/OUR KNOWLEDGE THE ODOMETER READING:
1. REFLECTS ACTUAL MILEAGE.
2. IS IN EXCESS OF ITS MECHANICAL LIMITS.
3. IS NOT THE ACTUAL MILEAGE.
DEALER SALES TAX REPORT AND VEHICLE TRADE IN INFORMATION (IF APPLICABLE)
7
FLORIDA SALES TAX REGISTRATION NUMBER
DATE OF SALE
DEALER LICENSE NUMBER
AMOUNT OF TAX
DEALER / AGENT SIGNATURE
YEAR OF TRADE IN
MAKE OF TRADE IN
TITLE NUMBER OF TRADE IN (IF KNOWN)
VEHICLE IDENTIFICATION NUMBER OF TRADE IN
www.flhsmv.gov
RULE 15C-21.001, FAC
HSMV 82040 – REV. 11/15
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR CERTIFICATE OF TITLE WITH/WITHOUT REGISTRATION
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/
CHECK APPLICATION TYPE:
ORIGINAL
TRANSFER
VEHICLE TYPE:
MOTOR VEHICLE
MOBILE HOME
VESSEL
OFF-HIGHWAY VEHICLE:
ATV
ROV
MC
1
OWNER / APPLICANT INFORMATION
Customer Number
Check this box if you are requesting
Owner
Co-Owner
Unit Number
Fleet Number
the certificate of title to be printed.
Are you a Florida resident?
yes
no
yes
no
Are you an alien?
yes
no
yes
no
Iiiiiii
OR
AND NOTE: When joint ownership, please indicate if “or” or “and” is to be shown on title when issued. If neither box is checked, the title will be issued with "and."
If applicable:
Life Estate/Remainder Person
Tenancy By the Entirety
With Rights of Survivorship
Owner's County of Residence: _____________________________________
Owner’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name)
Owner’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Co-Owner/Lessee’s Name As It Appears on Driver License (First, Full Middle/Maiden, & Last Name)
Co-Owner’s/Lessee’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Owner’s Mailing Address (Mandatory unless a member of the Military)
City
State
Zip
Co-Owner’s/Lessee’s Mailing Address (Mandatory unless a member of the Military)
State
Zip
City
Owner’s/Lessee’s Physical Street Address in Florida (Mandatory unless a member of the Military)
State
Zip
City
Check if in a mobile home rental park with 10 or more lots.
Mobile Home Physical Address
(if applicable)
State
Zip
City
\\
Mail To Customer Name (If different From Above Owner)
Mail To Customer’s Email Address
Date of Birth
Sex
FL Driver License or FEID/Suffix #
Mail To Customer Address (If different From Above Mailing Address)
City
State
Zip
2
MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTION
Vehicle/Vessel Identification Number
Make/Manufacturer
Year
Body
Color
Florida Title Number
License Plate or Vessel Registration Number
Previous State of Issue
Weight
Length
BHP/CC
GVW/LOC
VAN USE, IF APPLICABLE
Ft.
In.
PASSENGER
OTHER
TYPE
HULL MATERIAL
PROPULSION
FUEL
*DRAFT OF VESSEL
(The depth of water a
Open Motorboat
Houseboat
Personal Watercraft
Wood
Aluminum
Outboard
Sail
Gas
vessel draws)
Cabin Motorboat
Pontoon
Canoe
Fiberglass
Steel
Inboard
Air Propelled
Diesel
_________
Auxiliary Sailboat
Airboat
Other
Wood/Fiberglass
Inboard/Outboard
Electric
______
______
FT.
IN.
Inflatable
Sailboat
Other______________________
Other__________________________
Other_________________
Specify
*
For all vessels 26’ or more in
Specify
Specify
Specify
length and all sailboats
USE OF VESSEL
PREVIOUS
OUT-OF-STATE
Recreational (Pleasure)
Commercial Blue Crab
Commercial Stone Crab
Government
Commercial Sponge
REGISTRATION NUMBER:
Dealer/Manuf.
Commercial Fish
Commercial Live Bait
Commercial Shrimp Recip.
Commercial Charter
Commercial Other ______________
Exempt
Hire (Livery)
Commercial Mackerel
Commercial Shrimp Non-Recip.
Commercial Oyster
Commercial Spiney Lobster
Previously Federally Documented Vessel, Attach Copy of:
State of Principal Use
U.S. Coast Guard Release From Documentation Form; or
Copy of Canceled Documentation Papers
3
BRANDS, USAGE AND TYPE (Check Applicable Boxes)
SHORT TERM LEASE
LONG TERM LEASE
REBUILT
POLICE VEHICLE
PRIVATE USE
TAXI CAB
FLOOD
ILEV
CUSTOM
ASSEMBLED FROM PARTS
BONDED TITLE
KIT CAR
GLIDER KIT
MANUF. BUY BACK
REPLICA
AUTONOMOUS
ELECTRIC
STREET ROD
4
LIENHOLDER INFORMATION
Date of Lien
Lienholder's Name
CHECK
FEID #
DL # and Sex and Date of Birth
DMV Account #
IF ELT
CUSTOMER
Lienholder’s Email Address
Lienholder's Address
City
State
Zip
If Lienholder authorizes the Department to send the motor vehicle or mobile home title to the owner, check box and countersign: ________________________________________________________________________
(Does not apply to vessels). If box is not checked, title will be mailed to the first lienholder.
(Signature of Lienholder’s Representative)
5
TRANSFER TYPE
IF OWNERSHIP HAS TRANSFERRED, HOW AND WHEN WAS THE VEHICLE, MOBILE HOME, OR VESSEL ACQUIRED?
DATE ACQUIRED
SALE
GIFT
REPOSSESSION
COURT ORDER
OTHER (SPECIFY) __________________________________________
_________/___________/______________
6
ODOMETER DECLARATION
WARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing a false statement may result in fines or imprisonment.
,
.
I/WE STATE THAT THIS
5 OR
6 DIGIT ODOMETER NOW READS
MILES, DATE READ _____ /_____ / ________ AND I/WE HEREBY CERTIFY
XX
(NO TENTHS)
THAT TO THE BEST OF MY/OUR KNOWLEDGE THE ODOMETER READING:
1. REFLECTS ACTUAL MILEAGE.
2. IS IN EXCESS OF ITS MECHANICAL LIMITS.
3. IS NOT THE ACTUAL MILEAGE.
DEALER SALES TAX REPORT AND VEHICLE TRADE IN INFORMATION (IF APPLICABLE)
7
FLORIDA SALES TAX REGISTRATION NUMBER
DATE OF SALE
DEALER LICENSE NUMBER
AMOUNT OF TAX
DEALER / AGENT SIGNATURE
YEAR OF TRADE IN
MAKE OF TRADE IN
TITLE NUMBER OF TRADE IN (IF KNOWN)
VEHICLE IDENTIFICATION NUMBER OF TRADE IN
www.flhsmv.gov
RULE 15C-21.001, FAC
HSMV 82040 – REV. 11/15
8
MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATION
THIS SECTION REQUIRES A PHYSICAL INSPECTION AND A VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER (VIN) (OR THE MOTOR NUMBER FOR MOTOR VEHICLES MANUFACTURED
PRIOR TO 1955) OF THE MOTOR VEHICLE DESCRIBED ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, OR FLORIDA DIVISION OF MOTOR VEHICLES
EMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE VIN IS VERIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER, THE VERIFICATION MUST BE SUBMITTED ON THEIR LETTERHEAD
STATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING TRAILERS, (WITH ABBREVIATION OF "TL" WITH A WEIGHT OF 2,000 POUNDS OR MORE) NOT CURRENTLY
TITLED IN FLORIDA.
I, the undersigned, certify that I have physically inspected the above described vehicle and find the vehicle identification number to be
:
(Vehicle Identification Number)
__________________________________ ___________________________________________________________________________ _____________________________________________________________________________________________
DATE
SIGNATURE
PRINTED NAME
Law Enforcement Officer or Florida Dealer/Agency Name _______________________________________________________ Badge # or Florida Dealer #
Notary Stamp or Seal
______________________
FL DMV/Tax Collector Employee
Florida Compliance Examiner/Inspector Badge or ID Number
______________________________________________
___________________________
COMMISSIONED NAME OF FLORIDA NOTARY: __________________________________________________ NOTARY'S SIGNATURE _________________________________________________
(Print, Type or Stamp)
9
SALES TAX EXEMPTION CERTIFICATION
THE PURCHASE OF A RECREATIONAL VEHICLE TO BE OFFERED FOR RENT AS LIVING ACCOMMODATIONS DOES NOT QUALIFY FOR EXEMPTION. I CERTIFY THE RECREATIONAL VEHICLE, MOBILE HOME OR VESSEL DESCRIBED HAS
BEEN PURCHASED AND IS EXEMPT FROM THE SALES TAX IMPOSED BY CHAPTER 212, FLORIDA STATUTES, BY:
CONSUMER’S CERTIFICATE OF EXEMPTION NUMBER
PURCHASER (STATE AGENCIES, COUNTIES, ETC.) HOLDS VALID EXEMPTION CERTIFICATE
MOTOR VEHICLE
MOBILE HOME
VESSEL WILL BE USED EXCLUSIVELY FOR RENTAL
SALES TAX REGISTRATION NUMBER
I hereby certify that ownership of the motor vehicle, mobile home or vessel described on this application, is not subject to Florida Sales and Use Tax for the following reason:
INHERITANCE
GIFT
DIVORCE DECREE
TRANSFER BETWEEN A MARRIED COUPLE
EVEN TRADE OR TRADE DOWN (State the facts of the even trade or trade down and the transferor information, including
the transferor's name and address, below under "Other: Explain.")
OTHER: (EXPLAIN)
10
REPOSSESSION DECLARATION
IF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:
I CERTIFY THAT THIS MOTOR VEHICLE, MOBILE HOME OR VESSEL WAS REPOSSESSED UPON DEFAULT IN THE TERMS OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
(VESSEL) A PHOTOCOPY OF THE LIEN INSTRUMENT FOR THE VESSEL IS REQUIRED AND ATTACHED.
I AM REQUESTING THAT AN ORIGINAL CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME IN LIEU OF A TITLE (REPOSSESSION).
I AM REQUESTING THAT A DUPLICATE CERTIFICATE OF REPOSSESSION BE ISSUED FOR THE MOTOR VEHICLE OR MOBILE HOME, AS THE ORIGINAL HAS BEEN LOST OR DESTROYED.
11
NON-USE AND OTHER CERTIFICATIONS
IF CHECKED, THE FOLLOWING CERTIFICATIONS ARE MADE BY THE APPLICANT:
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
THE VEHICLE IDENTIFIED WILL NOT BE OPERATED ON THE STREETS AND HIGHWAYS OF THIS STATE UNTIL PROPERLY REGISTERED.
THE VESSEL IDENTIFIED WILL NOT BE OPERATED ON THE WATERS OF THIS STATE UNTIL PROPERLY REGISTERED.
OTHER: (EXPLAIN) _________________________________________________________________________________________________________________________________________________________
12
APPLICATION ATTESTMENT AND SIGNATURES
I/WE PHYSICALLY INSPECTED THE ODOMETER/VIN AND FURTHER AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS. (More than one form HSMV 82040 may be used for additional signatures.)
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
_________________________________________________________________________________________________
_________________________________________________________________________________________________
SIGNATURE OF APPLICANT (OWNER)
Date
SIGNATURE OF APPLICANT (CO-OWNER)
Date
13
RELEASE OF SPOUSE OR HEIRS INTEREST
The undersigned person(s) state(s) as follows: That _________________________________________________________________________ died on _____________________________.
(Name of Deceased)
(Date)
testate (with a will)
intestate (without a will) and left the surviving heir(s) named below.
When applicable, the heir(s) (named below) certifies that the certificate of title is lost or destroyed.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
(More than one form HSMV 82040 may be used for additional signatures.)
Print or Type Name of Spouse, Co-owner or Heir(s)
Signature of Spouse, Co-Owner or Heir(s)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
That at the time of death the decedent was owner of the motor vehicle, mobile home or vessel described in section 2 of this form. The person(s) signing above hereby releases all of his/her/their right, title, interest and claim as
heir(s) at law, legatee(s), devisee(s), or otherwise to the aforesaid motor vehicle, mobile home or vessel to:
Name of Applicant(s) (Print or Type)
RESIDENTS OF FLORIDA AND ALL VESSEL OWNERS, RESIDING IN FLORIDA OR OUT OF STATE, SHOULD SUBMIT THIS FORM AND ALL REQUIRED DOCUMENTATION TO
A LOCAL FLORIDA TAX COLLECTOR’S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR
PROCESSING.
Check your local phone book government pages or visit the following website for current mailing
addresses:
http://www.flhsmv.gov/offices/
www.flhsmv.gov
HSMV 82040 – REV. 11/15
RULE 15C-21.001, FAC
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