Form HSMV 82995: Motor Vehicle Power of Attorney/Odometer Disclosure

Under VEHICLE DESCRIPTION, fill in the Vehicle Identification Number, Year, Make, Model, Body and Title No.

In Part A, print the Seller's Name; appoint the Name of Dealership/Business, as of the Date, as attorney-in-fact with full authority to transfer title, to satisfy any lien and to disclose the mileage for the vehicle described in Vehicle Description, exactly as stated in the following disclosure.

In Part A, enter what the 5 digit or 6 digit odometer now reads (no tenths) in miles, and the Date Read.

In Part A, hereby certify that to the best of knowledge the odometer reading: 1. reflects actual milage, 2. is in excess of its mechanical limits, 3. is not the actual mileage.

Federal law and State law require that you state the mileage in connection with transfer of ownership.

In Part A, under penalty of perjury, you declare that you have read the document and that the facts stated in it are true; fill in Seller's Signature, Seller's Printed Name and Seller's Street Address, City, State and Zip, and, if there is a Co Seller, Co Seller's Signature and Co Seller's Printed Name.

In Part A, fill in Purchaser's Signature, Purchaser's Printed Name, Purchaser's Dealership Name, Dealer License No. and Business Address, City, State and Zip.

Part B is invalid unless Part A has been completed. In Part B, print Purchaser's Name; appoint the Name of Dealership/Business, as of the Date, as attorney-in-fact for the purpose of and with full authority to apply for title and/or registration, to file a lien and to sign the mileage disclosure on the title for the vehicle described in Vehicle Description, only if the disclosure is exactly as the disclosure completed in Part B.

In Part B, enter what the 5 digit or 6 digit odometer now reads (no tenths) in miles, and the Date Read; hereby certify that to the best of knowledge the odometer reading: 1. reflects actual milage, 2. is in excess of its mechanical limits, 3. is not the actual mileage.

In Part B, fill in Seller's Signature and Seller's Printed Name (For Dealership / Business), Purchaser's Signature and Purchaser's Printed Name, and, if there is a Co Purchaser, Co Purchaser's Signature and Co Purchaser's Printed Name.

In Part B, fill in Business Address, City, State, Zip, and Purchaser's Name, Street Address, City, State, Zip.

Person completing Part C must be the same person transferring information and signing the title. I, Print Name of Person exercising power(s) of attorney, hereby certify that the mileage I have disclosed on the title document is consistent with that provided to me in the power(s) of attorney. Further, upon examination of the title and any reassignment documents for the vehicle described in Vehicle Description, the mileage disclosure I have made on the title pursuant to the power of attorney is the same or greater than that previously stated on the title reassigned documents. This certificate is not intended to create, nor does it create any new or additional liability under Federal or State law.

In Part C, fill in Signature, Date, Printed Name and Street Address, City, State and Zip.

Original: to be attached to the certificate of title when obtained and is to remain with the title until the application for title is made for the purchaser.

Second copy: to be retained by the dealer for a period of five (5) years.

Third copy: to be given to the seller who completed the power of attorney in Part A.

Original: DMS Copy (with Title); Gold Copy: Dealer/Business; Yellow Copy: Part A Seller.

This form should be used when the certificate of title is physically held by a lienholder and is not available for endorsement for transfer and odometer disclosure, or when the certificate of title has been lost or destroyed and is not available for endorsement for transfer and odometer disclosure.

This form is not required when the motor vehicle is exempt from the odometer disclosure requirements under federal and state law.

These exemptions are: motor vehicles with a model year of 2011 or newer are exempt after twenty (20) years and motor vehicles with a model year of 2010 or older are exempt after ten (10) years; motor vehicle is not self propelled; motor vehicle has a gross vehicle weight rating (GVWR) of more than 16,000 pounds.

If a power of attorney form is needed for an exempt vehicle (see the list of exemptions), use form HSMV 82053.

If the motor vehicle is being sold to an out of state purchaser or an out of state dealer, the Florida dealer must photocopy the completed original of this form and mail directly to the department within five (5) business days after the certificate of title and dealer reassignment form are delivered by the dealer to its purchaser.

Providing a false statement may result in fines or imprisonment.