HSMV 83091 Form – Fill Out and Use This PDF

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 __________________________

__________________ ________ _____________ ____________________________________

Make of Vehicle Type ColorIdentification Number

BY: __________________________________________________________________________

Name of Issuing Agency/Dealer & Dealer’s License Number, If Applicable

______________________________________________________________________________

Street Address of Issuing Agency/Dealer

_____________________________________________________________________________________________________________________

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/