Form HSMV 84003 at a glance
What it is: HSMV 84003 is the Florida Department of Highway Safety and Motor Vehicles Receipt and Certificate of Disposal for Obsolete License Plates.
Who signs: Sign at SIGN: Signature of Agency Employee, Signature of DL Employee, Signature of the Dealership's Employee, or Signature of the Employee.
A filled-in Form HSMV 84003 example: a dealership surrenders old plates
How to fill out Form HSMV 84003, box by box
Who surrendered the plates
The License Plates listed under Beginning License Plate Number were surrendered by one of the following:
Name of Tax Collector/License Plate Agent and Agency #, Name of Driver License Office, Name of Dealership and County Location, or Other Source.
License plate numbers and totals
In each row, enter the Beginning License Plate Number, the Ending License Plate Number and the Total. Enter a Grand Total.
Plates received and destroyed
The vendor or company that receives the plates enters its Name of Vendor/Company and the Date Received.
The vendor employee who destroyed the plates fills in this part. By that employee: "I certify that these license plates have been destroyed by me in accordance with Department procedures." That employee enters the Name of Vendor Employee and the Date of Disposal.
Submit a copy with Plates to Pride.
More rules for Form HSMV 84003
The surrendering Tax Collector, License Plate Agent, or DMS office must retain a copy of the completed form for their records for 12 months.
Common questions about Form HSMV 84003
Where do I file it?
Once completed, fax, mail, or email to the Revenue Audit Section. Fax: (850) 617-5219. Mail to: Division of Motorist Services, Neil Kirkman Bldg., MS #24, Tallahassee, FL 32399. Email: RevenueAudit@flhsmv.gov
Sources
[1] Form HSMV 84003 (09/2023), Receipt and Certificate of Disposal for Obsolete License Plates, Florida Department of Highway Safety and Motor Vehicles (the Official source link on this page).