Form Hsmv 82039 - Application For Multiple Certificates Of Title With/without Registrations

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STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE

APPLICATION FOR MULTIPLE CERTIFICATES OF TITLE WITH/WITHOUT REGISTRATIONS

(Instructions on Reverse Side)

APPLICANT IDENTIFICATION

Owner/Lessor Name

Owner/Lessor Email Address

FEID #

Sex

Fleet #

Owner/Lessor’s Address

City

State

Zip

Lessee’s Name

Lessee’s Email Address

Date of Birth

Sex

Lessee’s Mailing Address

City

State

Zip

Owner/Lessee’s Street Address in Florida (Mandatory)

City

State

Zip

TRANSFER TYPE AND STATUS

IF OWNERSHIP HAS TRANSFERRED, HOW WERE VEHICLES OR VESSELS ACQUIRED?

SALE

GIFT

REPOSSESSION

COURT ORDER

OTHER (SPECIFY) _____________________

DATE ACQUIRED ___________________________

NEW

USED

LEASE:

SHORT TERM

LONG TERM

PRIVATE

TAXI CAB

POLICE

LIENHOLDER INFORMATION

FEID #

Date of Lien

Lienholder Name

Lienholder Email Address

Lienholder Address

City

State

Zip

(DOES NOT APPLY TO VESSELS)

If Lienholder authorizes the Department to send title to the owner, check box and countersign. _______________________________________________________________________

If box above is not checked, title will be mailed to first lienholder.

Signature of Lienholders Representative

MOTOR VEHICLE , MOBILE HOME OR VESSEL DESCRIPTIONS

YEAR

MAKE/MANUFACTURER

BODY

WEIGHT/LENGTH

ODOMETER STATUS

I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE MILEAGE THAT I CHECKED IS THE TRUE AND CORRECT MILEAGE.

INITIAL

VIN / HIN

LICENSE PLATE

COLOR

ODOMETER

DATE

TITLE NUMBER

(IF VIN

STATE

READING

READ

ISSUE

VERIFIED

REGISTRATION

VEHICLE

DATE

BY OWNER)

NUMBER

TYPE

HULL MATERIAL

PROPULSION

FUEL

1. Open Motorboat

5. Houseboat

1. Wood

4. Fiberglass

1. Outboard

4. Inboard/Outboard

1. Gas

2. Cabin Motorboat

6. Pontoon

2. Aluminum

5. Wood/Fiberglass

2. Inboard

5. Air Propelled

2. Diesel

3. Auxiliary Sailboat

7. Personal Watercraft

3. Steel

6. Other__________

3. Sail

6. Other_______

3. Other________

4. Inflatable

8. Other ___________

Specify

USE OF VESSEL

LENGTH OF VESSEL

*DRAFT OF VESSEL

OWNER

CO-OWNER

1. Pleasure

Are you a Florida

(The depth of water a vessel draws)

2. Dealer

resident?

yes

3. Manufacturer

FT. _____ IN._____

FT. ________

IN.________

4. Pleasure Canoe

Are you an alien?

yes

5. Commercial Canoe

6. Commercial

Contribution To Election Campaign Financing Trust Fund

*For all vessels 26’ or more in length and all

7. Exempt

sailboats

Previously Federally Documented Vessel, Attach Copy of:

Previous Out-of-State Registration Number:

1. U.S. Coast Guard Release From Documentation Form; or

2. Copy of Canceled Documentation Papers

VEHICLE IDENTIFICATION NUMBER VERIFICATION

COMPLETION OF THIS PART REQUIRES A PHYSICAL INSPECTION OF EACH MOTOR VEHICLE AND EACH VEHICLE IDENTIFICATION NUMBER (VIN) DESCRIBED ON THIS FORM BY A LICENSED

DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, FLORIDA DIVISION OF MOTORIST SERVICES EMPLOYEE OR FLORIDA TAX COLLECTOR EMPLOYEE. IF THE VINS ARE VERIFIED BY AN OUT OF

STATE MOTOR VEHICLE DEALER, THE VERIFICATIONS MUST BE SUBMITTED ON THEIR LETTERHEAD STATIONERY. COMPLETE THIS SECTION ON ALL USED MOTOR VEHICLES, INCLUDING

TRAILERS (WITH ABBREVIATION OF "TL" AND 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 vehicles and find vehicle identification numbers on each vehicle to be identical to the vehicle identification

numbers recorded on this form.

__________________________

___________________________________________________

_____________________________________________

(DATE)

(SIGNATURE)

(PRINTED NAME)

Law Enforcement, Agency

Badge or

_______________________________________________________ FL.

(Notary Stamp)

or FL. Dealer's Name:

Dealer #:__________________________

Florida DMV/Tax Collector Employee: _________________________________________________ Florida Compliance Examiner/Inspector Badge or ID Number ___________________

___________________________________________________________

Commissioned Name of Florida Notary: ___________________________________________________ Notary's Signature: __

HSMV 82039 (Rev. 12/11) S