Affidavit Occasional Or Isolated Sale Of A Motor Vehicle

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Affidavit
DR-99A
R. 01/17
Occasional or Isolated Sale of a Motor Vehicle
Rule 12A-1.097
Florida Administrative Code
Effective 01/17
When do I use this form? Use this affidavit
You may use this affidavit, signed by both parties
when applying for a vehicle title with the Florida
to the vehicle sale, to verify the price paid for the
Department of Highway Safety and Motor
vehicle.
Vehicles, a tax collector, or a private tag agency
to report the price paid for a motor vehicle sold
When any party to the sale under reports the
by an individual who is not a motor vehicle
vehicle price:
dealer. Florida law requires both the seller and
the purchaser of the motor vehicle to sign this
• Additional tax, a late-payment penalty,
affidavit.
a specific penalty of 200 percent of the
additional tax due, and interest is due to the
Florida law requires that if any party to an
Department; and
occasional or isolated sale of certain motor
• The party is subject to a first degree
vehicles reports a sales price less than 80
misdemeanor punishable as provided in
percent of the average loan price for the specific
section 775.082 or section 775.083, Florida
vehicle model and year, the Florida Department
Statutes.
of Revenue (Department) must request
verification of the vehicle price.
Motor Vehicle Information:
Make
Model
Vehicle Identification Number
Sales Price
The above described motor vehicle was sold by _______________________________(Name of Seller)
to _____________________________________________(Name of Purchaser) for the stated sales price
on _________________________________________(Date of Sale).
Describe the condition of the vehicle at the time of sale or purchase:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Under penalties of perjury, I declare that I have read the foregoing Affidavit and that the facts stated
in it are true to the best of my knowledge and belief. I understand that reporting a sales price less
than the actual sales price is a first degree misdemeanor and subject to a penalty equal to 200
percent of the additional tax due.
____________________________________________
___________________________________________
Signature of Seller
Signature of Purchaser
____________________________________________
___________________________________________
Date
Date

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