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    This document is a form for vehicle identification number and odometer verification required by the Florida Department of Highway Safety and Motor Vehicles. It includes an affidavit for the vehicle owner to certify ownership and odometer reading, as well as a section for verification by a notary or authorized personnel. The form emphasizes the legal implications of providing false information regarding the vehicle's mileage.

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    Sean Document

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    yzndash.6
    3 views1 page
    This document is a form for vehicle identification number and odometer verification required by the Florida Department of Highway Safety and Motor Vehicles. It includes an affidavit for the vehicle owner to certify ownership and odometer reading, as well as a section for verification by a notary or authorized personnel. The form emphasizes the legal implications of providing false information regarding the vehicle's mileage.

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    This document is a form for vehicle identification number and odometer verification required by the Florida Department of Highway Safety and Motor Vehicles. It includes an affidavit for the vehicle owner to certify ownership and odometer reading, as well as a section for verification by a notary or authorized personnel. The form emphasizes the legal implications of providing false information regarding the vehicle's mileage.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    3 views1 page

    Sean Document

    Uploaded by

    yzndash.6
    This document is a form for vehicle identification number and odometer verification required by the Florida Department of Highway Safety and Motor Vehicles. It includes an affidavit for the vehicle owner to certify ownership and odometer reading, as well as a section for verification by a notary or authorized personnel. The form emphasizes the legal implications of providing false information regarding the vehicle's mileage.

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    © All Rights Reserved
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    DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

    DIVISION OF MOTORIST SERVICES


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

    VEHICLE IDENTIFICATION NUMBER AND ODOMETER VERIFICATION


    PART A - OWNER’S VEHICLE IDENTIFICATION AFFIDAVIT AND ODOMETER DECLARATION
    (Completion of this part requires a physical inspection of the vehicle by the owner)
    AFFIDAVIT: DATE:
    This is to certify that I, the undersigned, am the lawful owner of the motor vehicle described on this form and that I have,
    on the date entered above, made a physical inspection of the motor vehicle and have recorded the vehicle identification
    number and other identification information and the odometer reading and certification in the spaces provided on this form.
    VEHICLE IDENTIFICATION (MOTOR NUMBER ALL MAKES THROUGH 1954 - IDENTIFICATION NUMBER 1955 AND LATER)

    Vehicle Identification Number Year Make Color Body Previous State Vehicle Titled In

    ODOMETER DECLARATION
    WARNING: Federal and State law require that you state the mileage in connection with an application for a
    Certificate of Title. Failure to complete or providing a false statement may result in fines and/or imprisonment.

    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 KNOWLEDGE
    THE ODOMETER READING:

    1. reflects ACTUAL MILEAGE. 2. is IN EXCESS OF ITS MECHANICAL LIMITS. 3. is NOT THE ACTUAL MILEAGE.

    UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING


    DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

    (Owner Signature) ( )

    PART B – VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER

    I, the undersigned, certify that I have physically inspected the above described vehicle and find the vehicle identification number
    to be identical to the vehicle identification number recorded on this form.

    UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT
    AND THAT THE FACTS STATED IN IT ARE TRUE.
    Date: (Seal)

    Commissioned Name of Florida Notary: Notary’s Signature:


    (Print, Type or Stamp)
    If other than a Notary, check the box below that applies, and sign and complete the corresponding fields. Verified by:
    Florida Compliance Examiner/
    Inspector(DMS/TC Employee) Law Enforcement Officer Florida Licensed Dealer

    Signature: Printed Name:

    Florida Compliance Examiner/Inspector Name: Badge or ID #:

    Law Enforcement Agency Name: LEO Badge #:

    Florida Dealer Name: Florida Dealer #:

    ◆ NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT ♦


    HSMV 82042 (REV. / / ) www.flhsmv.gov

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