Form Hsmv 83110 - Application For Registration Of A Motor Vehicle For Agricultural (Restricted), Horticultural (Restricted) Or "Goat" License Plate

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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 REGISTRATION OF A MOTOR VEHICLE FOR
AGRICULTURAL (RESTRICTED), HORTICULTURAL (RESTRICTED)
OR " GOAT" LICENSE PLATE
After reading the statutory provisions on the reverse side, complete the following
information:
Name of Applicant ______________________________________________________
Street Address _________________________________________________________
City ______________________________ State _________ Zip __________________
The undersigned is the registered owner or authorized driver of the following described
motor vehicle:
Make ____________ Year ________ Current License Plate Number ______________
Vehicle Identification Number ____________________ Title Number ______________
Agricultural or Horticultural Products (My signature below certifies that the
above described vehicle is not being operated as a "for-hire" vehicle and I am
hauling unprocessed agricultural or horticultural products within a 150-mile radius
of the above vehicle's home address.)
Goat (My signature below certifies that the above described vehicle will be used for
the transportation of crops and/or supplies, including required sanitary equipment
and towing of farm trailers.)
Will the above vehicle be used to carry loads over public roads?
Yes
No
Under penalties of perjury, I declare that I have read the foregoing document and
that the facts stated in it are true and made for the purpose of obtaining a license
plate with classification of " restricted" or " Goat" for the above described motor
vehicle.
______________________________________________
_____________________
(
(
Signature of Owner or Authorized Driver of the Motor Vehicle)
Date)
Check your local phone book government pages or visit the following website for current mailing addresses:
HSMV 83110 (Rev. 10/11) S

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