Form Hsmv 82100 - Affidavit For Change/alteration Of Body

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STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
Neil Kirkman Building - Tallahassee, FL 32399
AFFIDAVIT FOR CHANGE/ALTERATION OF
BODY
Date _____________________________________________________
This is to certify that ________________________________________ is
(Owner of Vehicle)
the lawful owner of a _________________________________________.
(Year)
(Make)
(Body Type)
Florida Title Number (if applicable)
__________________________________
___________________________________
Vehicle Identification Number
Affiant further states that the _____________________________
(Body Type shown on MCO or Title)
body has been removed from said vehicle (or the body has been altered)
and a __________________________________ body installed; and the
(Body Type Currently On Vehicle)
Florida Title (as shown above) or the Manufacturer's Certificate of Origin
is herewith surrendered for correction/issuance, in order to properly
identify the body type of the above described vehicle.
Current/Correct Weight of Vehicle _____________________________
(Weight as shown on Weight Slip)
Under penalties of Perjury, I Declare That I Have Read The Foregoing
Document and That The Facts Stated In It Are True.
_________________________________________ ____________________________
(Signature of Owner)
(Date)
HSMV 82100 (Rev. 5/01)

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