STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
www.flhsmv.gov/offices/
APPLICATION FOR TEMPORARY LICENSE PLATE
TEMPORARY LICENSE PLATE NUMBER: ________________________________________
THIS IS TO CERTIFY THAT ___________________________________________________
Name(s) (Applicant/Co-Applicant)
______________________________________________________________________________
Street Address (Post Office Box/Drawer, If Applicable)
______________________________________________________________________________
CityStateZip
Applicant’s Driver License NumberCo-Applicant’s Driver License Number
HAS MADE APPLICATION FOR AND HAS BEEN ISSUED A TEMPORARY LICENSE PLATE ON _____________________ NOT VALID AFTER __________________________
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FOR THE FOLLOWING MOTOR VEHICLE: |
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__________________ ________ _____________ ____________________________________
Make of Vehicle Type ColorIdentification Number
BY: __________________________________________________________________________
Name of Issuing Agency/Dealer & Dealer’s License Number, If Applicable
______________________________________________________________________________
Street Address of Issuing Agency/Dealer
_____________________________________________________________________________________________________________________
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AUTHORIZED ISSUING AGENCY USE ONLY |
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This temporary license plate will be issued solely for demonstration purposes. |
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This temporary license plate will be used solely for the delay in the manufacture of a |
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personalized license plate. |
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This temporary license plate will be issued solely for other purposes, please explain:
______________________________________________________________________________
______________________________________________________________________________
Signature of Applicant(s): ______________________________________________________
INSTRUCTIONS
The original (accurately completed) of this form must be given to the APPLICANT. This form is issued to the applicant as a temporary permit and must be carried in his/her possession at all times while the vehicle is being operated with the temporary license plate (until expiration).
THE TEMPORARY LICENSE PLATE MUST BE DESTROYED WHEN:
1.The regular license plate is received by the applicant.
2.The temporary license plate expires.
A copy of this form must be retained by the authorized issuing agency for a least one (1) year.
WARNING: Any person unlawfully using any such temporary license plate or violating any rule or regulation issued by the Division of Motor Vehicles pursuant to this act shall be guilty of a misdemeanor of the second degree.
Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/
HSMV 83091 (Rev. 10/11) |
www.flhsmv.gov |