Form Hsmv 84058 PDF Details

In the bustling world of vehicle sales and ownership in Florida, understanding and adhering to environmental regulations is paramount. The HSMV 84058 form plays a critical role in this landscape, serving as a crucial document that ensures vehicles, particularly automobiles and light-duty trucks from the year 1975 onwards, comply with air pollution control standards. This form helps to prevent the tampering of air pollution control devices or systems which are essential for mitigating the vehicle's environmental impact. Florida law takes a firm stance against the operation, sale, lease, or transfer of title of any vehicle that has been unlawfully modified in this regard. The form requires sellers to certify that the vehicle's emissions control devices, originally installed by the manufacturer or importer, have not been altered adversely. It encapsulates a process of thorough inspection, ensuring these systems are intact and functionally connected, although it doesn't guarantee their operation post-sale. The form serves as a testament to the vehicle's compliance at the time of the transaction, fostering transparency between seller and buyer while emphasizing the shared responsibility toward environmental consciousness.

QuestionAnswer
Form NameForm Hsmv 84058
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshsmv 84058, Unvented, EVP, Florida

Form Preview Example

VEHICLE AIR POLLUTION CONTROL STATEMENT

Florida Law prohibits the operation, sale, lease, or transfer of title of any automobile or light-duty truck (1975 or newer, 10,000 pounds gross vehicle weight or less) that has been tampered with. "Tampering" means the dismantling, removal, or rendering ineffective of any air pollution control device or system which has been installed on the vehicle by the vehicle manufacturer except to replace such device or system with a device or system equivalent in design and function to the part that was originally installed on the motor vehicle (316.2935, Florida Statutes).

As a motor vehicle dealer licensed to conduct business in the State of Florida, I hereby certify that the following air pollution emission control devices and system of this vehicle, if installed by the vehicle manufacturer or importer, have not been tampered with by me or by my agents, employees, or other representatives. I also hereby certify that I or persons under my supervision have inspected this motor vehicle and, based on said inspection, have determined that the air pollution control devices and systems listed below, if installed by the vehicle manufacturer or importer, are in place and appear properly connected and undamaged as determined by visual observation.

This certification shall not be deemed or construed as a warranty that any air pollution control device or system of the vehicle is in functional condition, nor does the execution or delivery of this certification create by itself grounds for a cause of action between the parties to this transaction.

MAKE:

MODEL:

BODY TYPE:

VIN:

YEAR:

Transferor's (Seller's) Signature: __________________________________________________________

Transferor's (Seller's) Printed Name: ______________________________________________________

Transferor's (Seller's) Street Address: ______________________________________________________

City: __________________________ State: ________________ Zip Code: _____________________

Date of Statement: _____________________________________________________________________

Transferee's (Buyer's) Signature: _________________________________________________________

Transferee's (Buyer's) Printed Name: ______________________________________________________

Transferee's (Buyer's) Street Address: _____________________________________________________

City: __________________________ State: ________________ Zip Code: _____________________

1975 – 1980 Model Year:

1981 or Newer Model Year

Catalytic Converter

Catalytic Converter

Fuel Inlet Restrictor

Fuel Inlet Restrictor

Unvented Fuel Cap

Unvented Fuel Cap

 

Exhaust Gas Recirculation System (EGR)

 

Air Pump and/or Air Injection System (AIS)

 

Fuel Evaporative Emissions System (EVP)

_______________________________________

 

Stock No.

 

 

Form approved by the Department of Environmental Protection

HSMV 84058 (06/10)

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Completing section 1 in Recirculation

2. Once your current task is complete, take the next step – fill out all of these fields - Transferors Sellers Signature, Catalytic Converter Fuel Inlet, Form approved by the Department of, Stock No, and Model Year Catalytic Converter with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

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