Form Hsmv 83091 - Application For Temporary License Plate
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1STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
2900 APALACHEE PARKWAY
NEIL KIRKMAN BUILDING
TALLAHASSEE, FLORIDA 32399
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)
_____________________________________________________________________________
City
State
Zip
Applicant Driver License Number
Applicant Driver License Number
Co-
HAS MADE APPLICATION FOR AND HAS BEEN ISSUED A TEMPORARY LICENSE
PLATE ON _____________________ NOT VALID AFTER _________________________
Month/Day/Year
Month/Day/Year
FOR THE FOLLOWING MOTOR VEHICLE:
__________________ ________ _____________ ____________________________________
Make of Vehicle
Type
Color
Identification Number
__________________________________________________________________________
BY:
Name of Issuing Agency/Dealer & Dealer’s License Number, If Applicable
______________________________________________________________________________
Street Address of Issuing Agency/Dealer
_____________________________________________________________________________________________________________________
City
State
Zip
AUTHORIZED ISSUING AGENCY USE ONLY
This temporary license plate will be issued solely for demonstration purposes.
This temporary license plate will be used solely for the delay in the manufacture of a
personalized license plate.
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.
HSMV 83091 (Rev.09/09)
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