Motor Vehicle A Driver

AFFIDAVIT

STATE OF FLORIDA

COUNTY OF PINELLAS

The undersigned hereby certifies the following facts and statements checked regarding the motor vehicle, vessel, or mobile home described below:

YEAR MAKE VEHICLE IDENTIFICATION NUMBER The above described vehicle needs major repair work. and are known to be one and the same person. Correction of Purchasers Name: I do hereby swear that never took possession of the above described motor vehicle, vessel, or mobile home. The name lined through was entered in error and no fraud was intended.

I am the owner of a moped described above. This vehicle was purchased on / / . I do not have a Bill of Sale or any other proof of purchase.

I have a military service related license plate or will be the applicant for said license plate. will be listed as the “registrant” on a vehicle titled in the name of a trust and will have beneficial use of the vehicle.

I am making application for a military service related license plate as the un-remarried surviving spouse of: Ex-Prisoner of War

Purple Heart recipient

I am the owner of the vehicle described above and hereby request the vehicle be classified as a recreational vehicle for the following reasons:

Installed 110 volt electrical wiring

Installed LP gas piping

Installed plumbing system

The above described vehicle has not been will not be operated on the public highways of Florida. This vehicle has been maintained in dead storage since the last registration period. The last year of registration was and the last validation decal number was . The vehicle with id # has been disposed of as described in Section 320.072 of the Florida Statutes.

The odometer information on the attached is incorrect due to . The actual mileage should be see form 82993.

Other: Plate not available for surrender

**ACCEPTABLE PROOF OF IDENTIFICATION MUST BE PROVIDED THE FORM OF A DRIVER LICENSE OR IDENTIFICATION

Section 320.02(5)(a) and 627.733, Florida Statutes, require every owner or registrant to maintain personal injury protection (PIP) and property damage liability (PDL) through a Florida insurance agent, continuously throughout the registration period. This is required on a motor vehicle with four or more wheels, which has a valid Florida license plate and registration. (If you cancel your insurance on your vehicle, you should make every effort to obtain the current physical license plate and surrender it to the department to avoid suspension of your driver license. This may not be possible in the case of a stolen license plate. In this instance, however, you are responsible for reporting that license plate was stolen.) The Florida license plate number is lost/destroyed/stolen is not available for surrender, and if found will not be affixed to any motor vehicle. I am requesting that the registration and license plate be marked “CANCELLED” in DMV records.

“Under penalties of perjury, I declare that I have read the forgoing document and that the facts stated in it are true.”

Signature of Affiant / Seller / Registrant

Printed Name of Affiant / Seller/ Registrant

Date:

DL / ID Card #:

UDS305 rev2013May16

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