FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLESAPPLICATION FOR CERTIFICATE OF MOTOR VEHICLE TITLE
Please submit this form to your local tax collector office or license plate agency.
https://www.flhsmv.gov/locations
Note: All fields are required unless otherwise stated or not applicable.

Application Type: ☐ Original ☐ Transfer
Off-Highway Vehicle Type: ☐ All-Terrain Vehicle (ATV)

Request to print Certificate of Title: ☐ No ☐ Yes: In office ☐ Yes: Mailed☐ Recreational Off-Highway Vehicle (ROV)☐ Off-Highway Motorcycle (OHM)

Section 1: OWNER/APPLICANT INFORMATION
Customer Number
Fleet Number

IOwner Details:

Unit Number

Owner's County of ResidenceII

I Are you a Florida Resident? ☐YES ☐ NO I Are you a US Citizen? ☐YES ☐NO I Are you deaf or hard of hearing? (Voluntary) ☐YES ☐NO

Select, if applicable:
When joint ownership, please indicate if “or” or “and” is to be shown on title when issued.
☐ OR
☐ AND
(If neither box is checked, the title will be issued with "and.")☐ Tenancy by the Entirety
Owner’s Name as It Appears on Driver LicenseOwner’s Phone Number
Owner’s Email (Voluntary)

I(First, Full Middle/Maiden, & Last Name)FL DL/ID or FEID/Suffix Number(Voluntary)

Owner’s Mailing Address

I

Owner’s Residential Street Address
Mail To Customer Name (If different from above owner)

FL DL/ID or FEID/Suffix Number

Mail To’s Phone Number(Voluntary)

Mail To’s Address (If different from above mailing address)☐ Life Estate/Remainder Person☐ With Rights of Survivorship
Sex
Date of Birth

CityState

Zip CodeCityStateZip Code

Mail To’s Email (Voluntary)

Sex

Date of Birth

CityState

Zip CodeI

Co-Owner Details: I Are you a Florida Resident? ☐YES ☐NO I Are you a US Citizen? ☐YES ☐NO I Are you deaf or hard of hearing? (Voluntary) ☐YES ☐NO
Co-Owner’s Email (Voluntary)
Sex
Date of Birth☐ Co-Owner or ☐ Lessee’s Name as It Appears on Driver License Co-Owner’s Phone Number(Voluntary)(First, Full Middle/Maiden, & Last Name)FL DL/ID or FEID/Suffix Number

Co-Owner’s/Lessee’s Mailing AddressI

Co-Owner’s/Lessee’s Residential Street Address
Section 2: MOTOR VEHICLE DESCRIPTION
Vehicle Identification Number (VIN)

Florida Title Number

Make/Manufacturer

ModelYear

Van Use (If applicable)☐Passenger☐OtherFuel Type☐ Natural Gas (Liquid)

BodyColorII☐ Natural Gas (Compressed)

Section 3: BRANDS, USAGE AND TYPE (Check applicable types)☐Assembled from Parts☐Autonomous☐Bonded Title ☐Custom☐Long Term Lease☐Manuf. Buy Back
☐Police Veh.
☐Private UseCity

State

Zip Code

City

State

Zip Code

License Plate Number

Previous State of Issue

II

LengthFt.___ In___1-☐ Hybrid (Gas/Electric)☐Electric☐Rebuilt☐Flood☐ReplicaWeightI

BHP/CCII☐ Hybrid (Diesel/Electric)☐Glider Kit☐Short Term Lease

Section 4: LIENHOLDER INFORMATION (If applicable)
ELT Customer ☐ FEID/Suffix # ☐DMV Account # ☐DL/ID #, Sex and DOB☐YES ☐NO

Lienholder’s Phone Number (Voluntary)

Date of LienCity

Lienholder’s Mailing Address

GVW☐ Electric☐Kit Car☐Taxicab☐ILEV☐Street Rod

Lienholder’s Email (Voluntary)

IStateZip CodeII

Lienholder’s Name (If box is not checked, title will be mailed to the first lienholder.) ☐ Check this box if you, lienholder representative, authorize the Department to send

Ithe motor vehicle title to the owner and sign here: ____________________

Section 5: TRANSFER TYPE (If applicable)
If ownership has transferred, how and when was the motor vehicle acquired?
☐Sale (Price: $__________ . ____ ) ☐Gift ☐ Repossession ☐Court Order☐Inheritance☐Other (Specify): ____________________

Date Acquired:

I_____ / _____ / _______

Section 6: ODOMETER DECLARATIONWARNING: Federal and State law requires that you state the mileage in connection with an application for a Certificate of Title. Failure to complete or providing afalse statement may result in fines or imprisonment.
I/we state that this ☐5 or ☐6-digit odometer now reads ___ ___ ___ , ___ ___ ___ .xx miles.

Date Read: _____ / _____ / _______.

I/we hereby certify that to the best of my/our knowledge the odometer reading:☐ 1. REFLECTS ACTUAL MILEAGE.
☐ 2. IS NOT THE ACTUAL MILEAGE.

☐ 3. IS IN EXCESS OF ITS MECHANICAL LIMITS.

(No tenths)

HSMV 82040 MV – Rev. 07/23

https://www.flhsmv.gov

RULE 15C-21.001, FAC

FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLESAPPLICATION FOR CERTIFICATE OF MOTOR VEHICLE TITLE
Section 7: DEALER SALES TAX REPORT AND MOTOR VEHICLE TRADE IN INFORMATION (If applicable)
Florida Sales Tax Registration Number
Dealer License Number
Date of Sale
Amount of Tax
Year of Trade In

Make of Trade In

Title Number of Trade In (If known)

Dealer/Agent Signature

Vehicle Identification Number (VIN) of Trade In

Section 8: MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATIONThis section requires a physical inspection and a verification of the vehicle identification number (VIN) (or the motor number for motor vehicles manufactured prior to1955) of the motor vehicle described on this form by a licensed Florida dealer, Florida notary public, law enforcement officer, or authorized FLHSMV, tax collector(TC) or license plate agency (LPA) employee. Complete this section on all used motor vehicles, including trailer (with abbreviation of “TL” and a weight of
2,000lbs or more), not currently titled in Florida.
I, the undersigned, certify that I have physically inspected the above-described vehicle:
Vehicle Identification Number (VIN)
Name Certifying Inspector
Certifying Inspector Signature
DateII

Select which option best represents the certifying inspector:

I☐ Florida Notary Public (Stamp or Seal)☐ Law Enforcement

Agency Name: ___________________________

Badge Number: _________________☐ Florida Dealer

Dealer Name:___________________________

Dealer Number: _________________☐ FLHSMV
Office Name: ___________________________☐ Tax Collector or
Agency Name: ___________________________
License Plate Agency

User ID/Badge: _________________County/Agency: _________________

Signature: ________________

Section 9: SALES TAX EXEMPTION CERTIFICATION (If applicable)
The purchase of a recreational vehicle to be offered for rent as living accommodations does not qualify for exemption. I certify the motor vehicle
described has been purchased and is exempt from the sales tax imposed by Chapter 212, Florida Statutes, by:☐ Purchaser (state agencies, counties, etc.) holds valid exemption certificate☐ Vehicle will be used exclusively for rental.

Consumer’s Certificate of Exemption Number: __________________

ISales Tax Registration Number: _________________________

I hereby certify that ownership of the motor vehicle described on this application, is not subject to Florida Sales and Use Tax for the following reason:☐ Inheritance☐ Gift☐ Divorce Decree☐ Transfer between a married couple☐ Other:_________________________☐ Even trade or trade down _____________________________________________________________________(State the facts of the even trade or trade down and the transferor information, including the transferor’s name and address.)

Section 10: REPOSSESSION DECLARATION☐ I certify that this motor vehicle was repossessed upon default in the terms of the lien instrument and is now in my possession.
Section 11: NON-USE AND OTHER CERTIFICATIONS
If checked, the following certifications are made by the applicant:☐ I certify that the certificate of title is lost or destroyed.
☐ The vehicle identified will not be operated on the streets and highways of this state until properly registered.

☐Other: (explain) _____________________________________________________________________________

Section 12: APPLICATION ATTESTMENT AND SIGNATURES
I/We physically inspected the VIN. (More than one form HSMV 82040 may be used for additional signatures.)
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
Full Name of Applicant, Owner
Signature of Applicant, Owner

Date

Full Name of Applicant, Co-Owner

Date

Signature of Applicant, Co-Owner

Section 13: RELEASE OF SPOUSE OR HEIRS INTEREST (If applicable)

The undersigned person(s) state(s) that ____________________________________________________________________ died on _______________.
(Name of deceased)☐ Testate (with a will)☐ Intestate (without a will) and left the surviving heir(s) named below.
☐ When applicable, the heir(s) (named below) certifies that the certificate of title is lost or destroyed.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
(More than one form HSMV 82040 may be used for additional signatures.)(Date)

Full Name of ☐ Spouse, ☐ Co-Owner or ☐ Heir(s)Signature of Spouse, Co-Owner or Heir(s)DateFull Name of ☐ Spouse, ☐ Co-Owner or ☐ Heir(s)Signature of Spouse, Co-Owner or Heir(s)DateThat at the time of death the decedent was owner of the motor vehicle described in section 2 of this form. The person(s) signing above hereby releases
all of his/her/their right, title, interest and claim as heir(s) at law, legatee(s), devisee(s), or otherwise to the aforesaid motor vehicle to:Full Name of Applicant
Signature of Applicant
Date
Full Name of Applicant

HSMV 82040 MV – Rev. 07/23

Signature of Applicant

https://www.flhsmv.gov

Date

RULE 15C-21.001, FAC