Hsmv 84491 Form PDF Details

In the intricate world of vehicle rebuilding and modifications, the HSMV 84491 form serves as an essential document for individuals and businesses involved in the restructuring of motor vehicles, motorcycles, and mobile homes. This paperwork, mandated by the State of Florida Department of Highway Safety and Motor Vehicles, plays a critical role in ensuring that all modifications and rebuilds meet the safety and regulatory standards set forth by the state. At its core, the HSMV 84491 form, also known as the Statement of Builder, requires detailed documentation of the vehicle's year, make, identification number, color, and body length, among other specifications. The form goes a step further to meticulously list major component parts utilized during the build or repair process, whether they're new, used, repaired, after-market, or homemade. Each component's source or Vehicle Identification Number (VIN) must be disclosed, guaranteeing a transparent footprint of the vehicle's transformation. The declaration segment of the form underscores the legal responsibility of the declarant to ensure the accuracy and completeness of the information provided, declaring under penalties of perjury that all disclosed facts are true and no material information has been omitted. This comprehensive approach to vehicle rebuilding documentation underscores the state's commitment to road safety and fraud prevention in the vibrant world of vehicle reconstruction.

QuestionAnswer
Form NameHsmv 84491 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other names83140 florida form, statement of builder, statement of builder form hsmv 84491 form, forida form hsmv 84491

Form Preview Example

STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

STATEMENT OF BUILDER

(Additional Sheet)

REBUILT ASPT COMBINED KIT CAR OTHER:

SECTION I. Description of:

MOTOR VEHICLE

MOTORCYCLE

MOBILE HOME

1._________ _____________ _________________________ __________ ____________ ______________

Year

Make

Identification Number

Color

Body

Length

SECTION II. MAJOR COMPONENT PARTS USED IN THE BUILDING/REPAIR PROCESS

2.Please continue to list the major component parts used in the building/repair process.

Part

New

Used

Repaired After Market

Homemade

Source/VIN

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NOTE: Major component parts defined as: For motor vehicles other than motorcycles, any fender, hood, bumper, cowl assembly, rear quarter panel, trunk lid, door, deck lid, floor pan, engine, frame, transmission, catalytic converter or airbag.

HSMV 84491 (Rev. 8/11)

3. Please continue to describe any repairs made.

SECTION III. TO BE COMPLETED AND SUBMITTED WITH ALL APPLICATIONS

Date: ____________________

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS ST ATED I N I T AR E T RUE. N O M ATERIAL I NFORMATION R EGARDING T HE M OTOR VE HICLE, MOTORCYCLE, OR MOBILE HOME HAS BEEN OMITTED.

__________________________________________

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PRINTED NAME OF APPLICANT/BUSINESS

PRINTED NAME OF CO-APPLICANT/BUSINESS

__________________________________________

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SIGNATURE OF APPLICANT/BUSINESS

SIGNATURE OF CO-APPLICANT/BUSINESS

HSMV 84491 (Rev. 8/11)

 

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