Form Hsmv 90510 - Motor Vehicle, Vessel An D Mobile Home Records Request

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DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
2900 Apalachee Parkway, Room B231, Mail Stop 91
Neil Kirkman Building - Tallahassee, FL 32399
M O T O R V E H I C L E , V E S S E L A N D M O B I L E H O M E R E C O R D S R E Q U E S T
F E E S A R E R E Q U I R E D A T T I M E O F R E Q U E S T A N D A R E P A Y A B L E T O D I V I S I O N O F M O T O R I S T S E R V I C E S .
P L E A S E A L L O W A 2 - W E E K P R O C E S S I N G T I M E F R O M T H E D A T E W E R E C E I V E T H I S R E Q U E S T .
Requester's Information:
Name of Requester
Date
Reference # (Case/File Name)
Street Address
To receive personal
information,
indicate the
Email Address
exemption number(s) from list. * If you request your
own personal information, see note below.
City
State
Zip
Fax Number
Under penalty of perjury, I affirm that I am entitled to receive this information and understand that
I may not redisclose this information according to the
Driver Privacy Protection
Act, except as
provided in section 119.0712(2), Florida Statutes.
Signature of Requester or Contact Person
Telephone Number
*NOTE: If requesting your own personal information you must include your DL/ID or social security number and sign this request.
Type of Record Request:
Motor Vehicle
Vessel
Mobile Home
(Records are available up to 10 years)
Certified Record Request (An additional $3.00 is required per record)
You may attach a separate sheet for additional requests.
Current Registration Request - $ .50 Each
VIN/HIN Number
Make
Year
Title Number
License Plate or FL #
Current Registered Owner
Owner (as of): Month _______ Day ______Year _________
OR
Title Record Request (By Vehicle/Vessel Identification Number or Title Number Only)
VIN/HIN Number
Title Number
Title History Printout (lists owner(s) of vehicle) - $1.00
-
Complete Title History (scanned Images)
$15.00
Specific Title Transaction - $1.00 Per Page
We request $15.00 as initial payment for each record. The fee is $1
________________________________
per page. If additional fees are required, we will contact you.
(Month, Day and Year)
MOTOR VEHICLE RECORD REQUEST BY NAME AND PERSONAL INFORMATION - $ .50 Each
_________________________________________________________________________________________________
First
Middle
Last
Date of Birth
Driver License/ID number
Social Security #
Identify what information needs to be stated in the letter of
Request for Letter(s) of Verification:
verification or what specifically you are requesting. (If additional
Examples of this request are for specific information such as
space is needed you may attach a separate sheet.)
make, model or body type of motor vehicle, or address on record
for a certain date, etc.
Letter of Verification - $1.00 each
Certified Letter of Verification - $4.00 each
HSMV 90510 - Revised 09/13

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