Form HSMV-86030 "Out of Business Affidavit" - Florida

What Is Form HSMV-86030?

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 June 1, 2006;
  • 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 HSMV-86030 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-86030 "Out of Business Affidavit" - Florida

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OUT OF BUSINESS
AFFIDAVIT
Division of Motor Vehicles (DMV)
Department of Highway Safety and Motor Vehicles
Date: _______________________________________
This affidavit verifies that the dealer license number referenced below has been suspended, revoked or is
otherwise no longer valid in the State of Florida.
Dealer Information:
Dealer’s Name: __________________________________________________
Address: ________________________________________________________
City, State, Zip Code: _____________________________________________
Dealer License Number: ___________________________________________
Consumer Information:
Consumer’s Name: ________________________________________________
Address: ________________________________________________________
City, State, Zip Code: ______________________________________________
Vehicle Purchased Information:
____________________
____________________
________________________________________
Vehicle Make
Vehicle Model Year
Vehicle Identification Number (VIN)
Vehicle Lien Holder Information:
There is No or Lien Holder Name: _____________________________________________________
Lien Holder
Lien Holder Address: ___________________________________________________
Lien Holder City/State/Zip Code: __________________________________________
DMV Regional Administrator Information:
Signature: _________________________________________________
Name: ____________________________________________________
Address: __________________________________________________
_______
City/State/Zip Code: ________________________________________
DMV
Telephone: ________________________________________________
Regional Office Stamp
Instructions: Take this original Out of Business Affidavit to the local Tax Collector’s Office along with originals or
copies of all documents of proof of purchase.
ONLY ORIGINAL AFFIDAVIT FORMS ARE VALID FOR ANY TRANSACTION
HSMV-86030 S (06/06)
OUT OF BUSINESS
AFFIDAVIT
Division of Motor Vehicles (DMV)
Department of Highway Safety and Motor Vehicles
Date: _______________________________________
This affidavit verifies that the dealer license number referenced below has been suspended, revoked or is
otherwise no longer valid in the State of Florida.
Dealer Information:
Dealer’s Name: __________________________________________________
Address: ________________________________________________________
City, State, Zip Code: _____________________________________________
Dealer License Number: ___________________________________________
Consumer Information:
Consumer’s Name: ________________________________________________
Address: ________________________________________________________
City, State, Zip Code: ______________________________________________
Vehicle Purchased Information:
____________________
____________________
________________________________________
Vehicle Make
Vehicle Model Year
Vehicle Identification Number (VIN)
Vehicle Lien Holder Information:
There is No or Lien Holder Name: _____________________________________________________
Lien Holder
Lien Holder Address: ___________________________________________________
Lien Holder City/State/Zip Code: __________________________________________
DMV Regional Administrator Information:
Signature: _________________________________________________
Name: ____________________________________________________
Address: __________________________________________________
_______
City/State/Zip Code: ________________________________________
DMV
Telephone: ________________________________________________
Regional Office Stamp
Instructions: Take this original Out of Business Affidavit to the local Tax Collector’s Office along with originals or
copies of all documents of proof of purchase.
ONLY ORIGINAL AFFIDAVIT FORMS ARE VALID FOR ANY TRANSACTION
HSMV-86030 S (06/06)