Attach the original MSO, bill of sale(s), or receipt(s) for all major component parts (must contain name, address, telephone, and signature of seller).
Custom vehicle or street rod: the statements are required to be attested to according to section 320.0863, Florida Statutes.
If not attested: failure to attest to these statements will cause this agency to reject your application.
Repairs: when Section II (1) is not applicable, describe the repairs made in detail.
Additional space: if additional space is needed, please use form HSMV 84491.
| Question | Answer |
|---|---|
| Form Name | Form HSMV 84490 |
| Form Length | 4 pages |
| Fillable? | Yes |
| Fillable fields | 135 |
| Avg. time to fill out | 23 min |
| Other names | HSMV 84490, HSMV84490, Form HSMV 84490, Statement of Builder, Florida Statement of Builder |
| Edition | Revised 05-2024 |
| Issuing agency | Florida Department of Highway Safety and Motor Vehicles |
| Additional space | Form HSMV 84491 |
| Official source | Form HSMV 84490 (Rev 05-2024), Florida Department of Highway Safety and Motor Vehicles |
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