Form Hsmv 83090 - Application By Florida Motor Vehicle, Motorcycle, Mobile Home Or Recreational Vehicle Dealer For Temporary License Plates
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1STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
APPLICATION BY FLORIDA MOTOR VEHICLE, MOTORCYCLE, MOBILE HOME OR
RECREATIONAL VEHICLE DEALER FOR TEMPORARY LICENSE PLATES
APPLICATION IS HEREBY MADE BY A FLORIDA MOTOR VEHICLE, MOTORCYCLE, MOBILE HOME OR
RECREATIONAL VEHICLE DEALER, (WHOSE NAME AND DEALER LICENSE NUMBER APPEARS BELOW)
FOR __________________________ TEMPORARY LICENSE PLATES, AS PROVIDED IN SECTION 320.131, F. S.
(Number of plates being requested)
TYPE OF TEMPORARY PLATES REQUESTED:
(regular)
(motorcycle)
REASON FOR REQUEST:
(Trailers under 2,000 lbs.)
(ETR Outages)
$ _______________
INCLUDED IS THE REQUIRED FEE OF:
__________________________________________________
NAME OF THE DEALER’S ETR/EFS VENDOR:
(The vendor’s name is required. Otherwise, provide an *explanation of why a vendor is not applicable.)
(*EXPLANATION): _______________________________________________________________________
____________________________________________________________________________
_______________________________________________________________
NAME OF THE DEALERSHIP:
________________________________________________________________________________________
Dealer’s Address
________________________________________________________________________________________
City
State
Zip
____________________
Dealer’s License Number:
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS
STATED IN IT ARE TRUE.
______________________________________________
____________________
SIGNATURE:
DATE:
(Authorized Representative for Dealership)
NOTE:
This form is to be accurately completed by the Florida motor vehicle, motorcycle, mobile home or recreational vehicle
dealer. The original form will be retained by the authorized issuing agency (DMS Regional Office or County License Plate
Agency) for a minimum of one year and a copy of this form will be returned to the dealership along with the temporary
license plates and the blank HSMV 83091 forms.
FOR AUTHORIZED ISSUING AGENCY ONLY
(DMS Regional Office or County License Plate Agency)
NUMBER OF TEMPORARY LICENSE PLATES ASSIGNED
: ___________________________________________________________________
ASSIGNED NUMBERS
FROM:
:
____________________________________ TO: _____________________________________________________
DATE LICENSE PLATES ASSIGNED:
ASSIGNED BY:
_______________
_________________________________________________________
HSMV 83090 (Rev.07/13)
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