Hsmv 84901S Form PDF Details

In a landscape where consumer rights and protections are increasingly scrutinized, the HSMV 84901S form emerges as a critical tool for individuals to report grievances related to vehicular transactions in the State of Florida. This comprehensive affidavit enables consumers to formally lodge complaints against motor vehicle, mobile home, and recreational vehicle dealerships, including manufacturers, with the Division of Motor Vehicles (DMV). Designed to address a range of issues, from deceptive sales practices to odometer fraud, the form serves as an essential mechanism for initiating investigations by the DMV. Providing detailed sections for the complainant's information, dealership details, and specific vehicle or mobile home information, the form ensures that all necessary data is captured to facilitate a thorough examination of the complaint. The document not only empowers consumers by providing a platform to voice their concerns but also underscores the accountability of dealers and manufacturers within the automotive industry. With regions across Florida designated to handle these submissions, the structured format of the HSMV 84901S form streamlines the process, guiding complainants through outlining the nature of their issue and articulating the resolution they seek, thereby fostering a clearer path to justice and consumer satisfaction.

QuestionAnswer
Form NameHsmv 84901S Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameshsmv 82191 fillable, hsmv 84901, hsmv 82191 pdf, dmv complaints florida

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DIVISION OF MOTOR VEHICLES

COMPLAINT AFFIDAVIT

FOR OFFICIAL USE ONLY

TYPE OF COMPLAINT

Motor Vehicle Dealer

Mobile Home Dealer

Mobile Home Manufacturer RVDealer/Manufacturer

Odometer Fraud

Other

Date Opened: ________________________ Date Closed: _______________________

Closing Code: __________________________________________________________

Complaint #: ___________________________________________________________

Investigator: ____________________________________________________________

COMPLAINANT INFORMATION

Name: ___________________________________________________________________________________________

Address: _________________________________________________________________________________________

City/County/State/Zip Code: __________________________________________________________________________

Home Telephone Number: __________________________ Work Telephone Number: ___________________________

E-mail Address: ___________________________________ FAX Number: ___________________________________

Date of Birth: _______________________________ Driver License Number: _________________________________

DEALERSHIP INFORMATION

Dealership Name: __________________________________________________________________________________

Address: _________________________________________________________________________________________

City/County/State/Zip Code: _________________________________________________________________________

E-mail Address: ___________________________________ FAX Number: ___________________________________

Dealer License Number (if known): ____________________________________________________________________

Owner’s Name (if known): ___________________________________________________________________________

Home Telephone Number: __________________________ Work Telephone Number: ___________________________

VEHICLE/MOBILE HOME/INSPECTION INFORMATION

Make/Model/Year: _______________________________ Date Purchased: ___________________________________

Vehicle Identification Number: ____________________________________ Tag Number: _______________________

MOBILE HOME, RECREATIONAL VEHICLE, OR PARK TRAILER INFORMATION

(Complete this section only if a mobile home, recreational vehicle or park trailer is involved in your complaint.)

Name of Manufacturer: ______________________________________________________________________________

Manufacturer’s Address: _____________________________________________________________________________

City/County/State/Zip Code: __________________________________________________________________________

HUD Label (red/silver metal tag on rear of unit): __________________________________________________________

Florida Seal Number if unit is a recreational vehicle or park trailer (by HUD Label or front): _______________________

HSMV 84901S (Rev. 10/08)

Please complete the reverse side of this form.

DMV COMPLAINT AFFIDAVIT

Page 2

DESCRIBE THE NATURE OF YOUR COMPLAINT: Please explain your complaint, listing events in the order in which they occurred. It is important to verify that dates listed are accurate. Enclose copies of any documentation you have related to your complaint.

WHAT ACTIONS DO YOU FEEL WILL SATISFY YOUR COMPLAINT?

Note: Please attach additional pages if necessary. Please also attach copies of ALL supporting documents, including purchase agreement, contracts receipts, cancelled checks, proof of vehicle insurance, registration, inspection reports, warranty documents, repair invoices or any other documents relating to your complaint.

SIGNATURE: ______________________________________________ DATE: ______________________________________

HSMV 84901S (Rev. 10/08)

BUREAU OF FIELD OPERATIONS' REGIONAL OFFICES

DIVISION OF MOTOR VEHICLES

Region I

Bureau of Field Operations, Region I

1135 Banks Road

Margate, Florida 33063

Telephone = (954) 969-4216

FAX = (954) 969-4237

Responsible for Broward County

Region II

Bureau of Field Operations, Region II

318 Southeast 25th Avenue

Ocala, Florida 34471

Telephone = (352) 732-1267

FAX = (352) 732-1459

Responsible for Alachua, Columbia, Gilchrist, Lake, Levy, Marion and Putnam Counties

Region III

Bureau of Field Operations, Region III 3200 Armsdale Road, Suite 13 Jacksonville, Florida 32218 Telephone = (904) 924-1524

FAX = (904) 924-1525 or 924-1530

Responsible for Baker, Bradford, Clay, Flagler, Duval, Nassau, St. Johns and Union Counties

Region IV

Bureau of Field Operations, Region IV

1354 South Woodland Boulevard

Deland, Florida 32720

Telephone = (386) 736-5108

FAX = (386) 736-5112

Responsible for Brevard, Seminole and Volusia Counties

Region V

Bureau of Field Operations, Region V

4101 Clarcona-Ocoee Road, Suite 160

Orlando, Florida 32810

Telephone = (407) 445-7400

FAX = (407) 445-7411

Responsible for Orange and Osceola Counties

Region VI

Bureau of Field Operations, Region VI

NET PARK, Suite 2228

5701 East Hillsborough Avenue

Tampa, Florida 33610

Telephone = (813) 612-7110

FAX = (813) 612-7111

Responsible for Citrus, Hernando, Hillsborough, Pasco, Pinellas, Polk and Sumter Counties

Region VII

Bureau of Field Operations, Region VII

Room C-205, Neil Kirkman Building, Mail Stop 76

Tallahassee, Florida 32399-0600

Telephone = (850) 617-2999

FAX = (850) 617-5180

Responsible for Dixie, Franklin, Gadsden, Hamilton, Jefferson, Lafayette, Leon, Liberty, Madison, Suwanee, Taylor and Wakulla Counties

Bureau of Field Operations, Panama City

6030 County Road 2321

Panama City, Florida 32404

Telephone = 850 872-4158

FAX = 850 872-7764

Responsible for Bay, Calhoun, Gulf, Jackson and Washington Counties

Bureau of Field Operations, Pensacola

185-C Airport Boulevard

Pensacola, Florida 32505

Telephone = 850 475-5415

FAX = 850 475-5423

Responsible for Escambia, Holmes, Okaloosa, Santa Rosa and Walton Counties

Region VIII

Bureau of Field Operations, Region VIII

323 10th Avenue West, Suite 200

Palmetto, Florida 34221

Telephone = (941) 723-4551

FAX = (941) 723-4553

Responsible for Charlotte, Collier, Desoto, Glades, Hardee, Hendry, Highlands, Lee, Manatee and Sarasota Counties

Region IX

Bureau of Field Operations, Region IX 470 Columbia Drive, Bldg. E, Suite 200 West Palm Beach, Florida 33409 Telephone = (561) 640-6820

FAX = (561) 640-6835

Responsible for Indian River, Okeechobee, Martin, Palm Beach and St. Lucie Counties

Region X

Bureau of Field Operations, Region X

1405 Southwest 107th Avenue, Suite 202 and 203C

Miami, Florida 33174

Telephone = (305) 222-4164

FAX = (305) 222-4180

Responsible for Dade and Monroe Counties

Updated 01-29-09

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Be mindful when filling out this form. Make certain all required fields are done accurately.

1. The dmv complaints florida usually requires certain details to be inserted. Ensure that the following blank fields are completed:

Completing section 1 of 84901s form

2. After filling out the last part, go on to the next part and complete all required particulars in all these blank fields - Dealership Name Address, Owners Name if known Home, VEHICLEMOBILE HOMEINSPECTION, MakeModelYear Date Purchased, MOBILE HOME RECREATIONAL VEHICLE, Complete this section only if a, and Name of Manufacturer.

The way to prepare 84901s form stage 2

A lot of people frequently make errors while completing Name of Manufacturer in this area. You should revise what you enter here.

3. This next part is fairly straightforward, DESCRIBE THE NATURE OF YOUR, and WHAT ACTIONS DO YOU FEEL WILL - these fields will need to be filled in here.

WHAT ACTIONS DO YOU FEEL WILL, DESCRIBE THE NATURE OF YOUR, and WHAT ACTIONS DO YOU FEEL WILL in 84901s form

4. The next section requires your attention in the following places: Note Please attach additional, and HSMV S Rev. Remember to fill out all required info to move forward.

84901s form conclusion process explained (part 4)

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