A P P L I C A T I O N F O R S A L V A G E T I T L E

A P P L I C A T I O N F O R S A L V A G E T I T L E

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flh...

124KB Sizes 0 Downloads 38 Views

Recommend Documents

H E L P P L A N T R A N S I T I N T O R O N T O
[email protected] tel: 416-338-2848 fax: 416-392-1591 www.smarttrack.to. Metrolinx [email protected] tel: 41

C l a s s i C s i i C o l l e C t i o n
C l a s s i C s i i C o l l e C t i o n. Page 2. Construction tip-sheared Patterned loop. Face fiber antron® legacy™

P e r s o n a l d e t a i l s D e s ire d re n ta l p ro p e D e c l a r a t i o
notification may only be provided in accordance with the German Data Protection Act (section 28, subsection. 2) insofar

T I P P S P I E L L Ö W E N F A N C L U B K A S I N G
T E I L 1. Name des Mitglieds: Abgegeben am: Spieltag. Begegnung. Tipp. 1. Fürth. -. TSV 1860 München. ___ : ___. 2. TSV

T H E J O U R N A L O F T H E E A S T I N D I A C L U B
the French Republic and Empire have been publicised, a military ..... France. The Civil War began and Henrietta Maria jo

C L A S S R O O M E D I T I O N
Apr 27, 2015 - CLOBBERED: defeated [A24] decisively or heavily. REPUDIATION: [A17] rejection. LACERATING: deeply distres

P L A N F E S T S T E L L U N G
01.01.2011 - Auslaufbauwerke mit einer Drosseleinrichtung. Für Regenereignisse, die das jeweilige Bemessungs- regenerei

E V A N G E L I O D E M A T E O
Los cuatro Evangelios contienen información común sobre la vida terrena y el ... Instrucciones: Contesta las siguiente

M O N I C A L I O N H E A R T
music was Monica's main goal. ... A long list of TV performances and several music video releases document the rapid ...

A C T A Z O O L O G I C A C R A C O V I E N S I A
Sandomierz; LH: Umg. Hrubieszów; Karpaten-Vorgebirge: Umg. Przemyśl. Bekannt aus Südpolen, vorwiegend in xerothermen

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES

THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

APPLICATION FOR SALVAGE TITLE/CERTIFICATE OF DESTRUCTION Instructions on Reverse Side

1

TOTAL LOSS BY INSURANCE COMPANY

TOTAL SALVAGE LOSS Insurance Company's Name

APPLICANT INFORMATION

TOTAL THEFT LOSS

Address

Address

City

State

Zip

City

Date Declared Total Loss and Compensation Paid Policy Number

State

Date of Loss FEID Number

Claim Number

Zip

Sex and Date of Birth

Driver License or Identification Card Number

Company’s E-Mail Address:

FEID #

DMV Account #

Owner’s E-Mail Address:

2

Vehicle Identification Number Previous State of Issue

3 4

UNINSURED OR SELF-INSURED

SALVAGE BY OWNER(S) (No Insurance Company Involved) Owner's Name

VEHICLE DESCRIPTION

Year

License Plate Number

Make

Weight

Body

Length

Color

Florida Title Number

BHP/CC

GVW/LOC

Florida Current Date of Issue

IMPORTANT: SEE VEHICLE IDENTIFICATION NUMBER VERIFICATION ON REVERSE SIDE OF THIS FORM SALVAGE TITLE/CERTIFICATE OF DESTRUCTION NOTATION INFORMATION

Lines a, b, c and d are not required to be completed for total theft loss or “insurance declared total loss” vehicles. a. Enter vehicle's current retail cost on this line ............................................................................................ (a) ____________________________ (Use any official used car or used mobile home guide) b. Multiply line (a) by .80, enter amount on this line ....................................................................................... (b) ____________________________ c. Enter estimate of cost to repair physical and mechanical damage on this line ........................................................................................................................................... (c) ____________________________ d. If amount on line (c) is less than amount on line (b), check the applicable box

………………………………

Rebuildable

Rebuildable Flood

e. If amount on line (c) is equal to or more than amount on line (b), OR If the insurance company wants to request a CD (even if the vehicle is worth less than $1,500), check here. ....... f. If vehicle is a total theft loss, check here. …………………………………………………………………….………..

Certificate of Destruction (unrebuildable) Total Theft Loss

g. The above described damaged vehicle is equipped with custom lowered floors for wheelchair access or a wheel chair lift and is repairable to a condition that is safe for operation on public roads. …………………………

5 6 7 8

“Insurance declared total loss” brand and rebuildable salvage

If applying for a duplicate Certificate of Destruction, check here. …………………..…………………………… If this transfer of title is exempt from Florida sales tax due to a settlement of an insurance claim, check here.

The undersigned applicant hereby certifies that the motor vehicle to be titled will not be operated upon the highways of this state.

ODOMETER DECLARATION

I/WE STATE THAT THIS

5 OR

,

6 DIGIT ODOMETER NOW READS

.XX (NO TENTHS) MILES, DATE READ

_______/______/_______, AND I/WE HEREBY CERTIFY THAT TO THE BEST OF MY/OUR KNOWLEDGE THE ODOMETER READING: 1. REFLECTS ACTUAL MILEAGE.

2. IS IN EXCESS Of ITS MECHANICAL LIMITS.

9

3. IS NOT THE ACTUAL MILEAGE. (WARNING – ODOMETER DISCREPANCY)

APPLICANT ATTESTMENT SIGNATURES

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE. I/WE AGREE TO DEFEND THE TITLE AGAINST ALL CLAIMS.

______________________________________________________ Applicant or Authorized Agent’s Signature

___________________________________________________ Applicant or Authorized Agent’s Printed Name

NOTE: Properly Assigned Certificate of Title MUST BE ATTACHED

10

FL. SALES TAX REGISTRATION NUMBER

HSMV 82363 (Rev.06/11)

DATE OF SALE

DEALER SALES TAX REPORT DEALER LICENSE NUMBER

www.flhsmv.gov

AMOUNT OF TAX

DEALER/AGENT SIGNATURE

MOTOR VEHICLE IDENTIFICATION NUMBER VERIFICATION THIS SECTION REQUIRES A PHYSICAL INSPECTION AND A VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER OF THE MOTOR VEHICLE DESCRIBED ON THIS FORM BY A LICENSED DEALER, FLORIDA NOTARY PUBLIC, POLICE OFFICER, FLORIDA DIVISION OF MOTORIST SERVICES EMPLOYEE OR TAX COLLECTOR EMPLOYEE. IF THE VIN IS VERIFIED BY AN OUT OF STATE MOTOR VEHICLE DEALER, THE VERIFICATION 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 vehicle described on side 1 of this form and found the vehicle identification number to be: VEHICLE IDENTIFICATION NUMBER

SIGNATURE PRINTED

SIGNATURE

Law Enforcement Officer or Florida Dealer/Agency Name

Badge Number or Florida Dealer Number

Florida DMV/Tax Collector Employee

Florida Compliance Examiner/Inspector Badge or ID Number

DATE

Notary's Signature___________________________________________ Printed Name of Florida Notary _______________________________ (Notary Stamp) (Print, Type or Stamp)

WHEN DOES THE VIN VERIFICATION ON THIS FORM NOT HAVE TO BE COMPLETED? THE VIN VERIFICATION ON THIS FORM DOES NOT HAVE TO BE COMPLETED ON NEW MOTOR VEHICLES, MOBILE HOMES, TRAVEL TRAILERS, CAMPING TRAILERS, FIFTH WHEEL RECREATIONAL VEHICLES, TRAILERS OR SEMI TRAILERS WITH A NET WEIGHT OF LESS THAN 2,000 POUNDS, WHEN A FLORIDA CERTIFICATE OF TITLE IS SUBMITTED AS PROOF OF OWNERSHIP OR WHEN FORM HSMV 82042 HAS BEEN COMPLETED AND IS ATTACHED.

WHEN SHOULD THE ODOMETER DECLARATION ON THIS FORM NOT BE COMPLETED?

THE ODOMETER DECLARATION IN SECTION 8 OF THIS FORM DOES NOT HAVE TO BE COMPLETED WHEN THE VEHICLE BEING TITLED IS EXEMPT FROM ODOMETER DISCLOSURE REQUIREMENTS. EXEMPTIONS: WHEN THE VEHICLE IS TEN YEARS OLD OR OLDER, HAS A GROSS VEHICLE WEIGHT RATING (GVWR) OF MORE THAN 16,000 POUNDS OR IS NOT SELF PROPELLED.

WHO IS AUTHORIZED TO USE THIS FORM? Any person, or authorized agent of any person or business, required to make application for a Florida Salvage Certificate of Title/Certificate of Destruction. WHEN SHOULD THIS FORM BE USED? 1. When an insurance company has paid a “Total Loss” on a motor vehicle or mobile home and must make application for a Salvage Certificate of Title/Certificate of Destruction in the name of the insurance company.

2. When an Uninsured or Self-Insured has a motor vehicle or mobile home that has been wrecked or damaged, and at the

time of loss the cost of repairing or rebuilding the motor vehicle or mobile home is 80% or more of the cost to the owner of replacing the wrecked or damaged motor vehicle or mobile home with one of like kind or quality.

3. When applying for a duplicate Certificate of Destruction.

NOTE: If requested, a Salvage Rebuildable or Salvage Rebuildable Flood certificate of Title for an uninsured motor vehicle or mobile home may be issued if the cost of repairing or rebuilding the vehicle is less than 80 percent.

FILING: 1. 2.

ALL APPLICABLE SECTIONS OF THIS FORM MUST BE COMPLETED LEGIBLY. THIS FORM MUST BE DOCUMENTED BY THE ATTACHMENT OF ONE OF THE FOLLOWING, UNLESS APPLYING FOR A DUPLICATE CERTIFICATE OF DESTRUCTION: (A) FLORIDA CERTIFICATE OF TITLE. (B) MANUFACTURER'S CERTIFICATE OF ORIGIN. (C) OUT-OF-STATE TITLE OR OTHER OFFICIAL PROOF OF OWNERSHIP. NOTE: When an insurance company pays the vehicle owner to replace the wrecked or damaged vehicle with one of like kind or quality, or when an insurance company pays the owner upon the theft of the motor vehicle or mobile home, the insurance company must have the title/Certificate of Destruction issued in their name. NOTE: A certificate of title will not be issued on a used motor vehicle that has been stolen from an out-of-state owner until the motor vehicle has been recovered and the required VIN verification can be performed. NOTE: This form has been combined with form HSMV 82042.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/ HSMV 82363 (Rev. 06/11)

www.flhsmv.gov