Form HSMV 84058 at a glance
What it is: Vehicle Air Pollution Control Statement: a dealer certifies that emission control devices, if installed by the manufacturer or importer, have not been tampered with by the dealer or its agents, employees, or other representatives.
Who signs: Sign on the Transferor's (Seller's) Signature line and on the Transferee's (Buyer's) Signature line.
A motor vehicle dealer licensed to conduct business in the State of Florida certifies 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 the dealer or by the dealer's agents, employees, or other representatives.
Under 1975 - 1980 Model Year: Catalytic Converter, Fuel Inlet Restrictor, Unvented Fuel Cap. Under 1981 or Newer Model Year: Catalytic Converter, Fuel Inlet Restrictor, Unvented Fuel Cap, Exhaust Gas Recirculation System (EGR), Air Pump and/or Air Injection System (AIS), Fuel Evaporative Emissions System (EVP).
A filled-in Form HSMV 84058 example: a dealer certifies a car it sells
How to fill out Form HSMV 84058, box by box
MAKE, MODEL, BODY TYPE, VIN and YEAR
Enter the MAKE, MODEL, BODY TYPE, VIN and YEAR.
Transferor's (Seller's)
Under Transferor's (Seller's), enter the Printed Name, Street Address, City, State, Zip Code and Date of Statement.
Transferee's (Buyer's)
Under Transferee's (Buyer's), enter the Printed Name, Street Address, City, State and Zip Code.
Stock No.
Enter the Stock No.
More rules for Form HSMV 84058
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.
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.
Common questions about Form HSMV 84058
Who signs it?
Sign on the Transferor's (Seller's) Signature line and on the Transferee's (Buyer's) Signature line.
What am I certifying when I sign?
The dealer certifies that the air pollution emission control devices and system of this vehicle, if installed by the vehicle manufacturer or importer, have not been tampered with by the dealer or by the dealer's agents, employees, or other representatives. The dealer also certifies that the dealer or persons under the dealer's supervision have inspected this motor vehicle and, based on said inspection, have determined that the air pollution control devices and systems listed on this statement, if installed by the vehicle manufacturer or importer, are in place and appear properly connected and undamaged as determined by visual observation.
Sources
[1] Form HSMV 84058 (06/10), Vehicle Air Pollution Control Statement, Florida Department of Highway Safety and Motor Vehicles (the Official source link on this page).