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Orange County, Florida

Intersection Safety Program

Affidavit Establishing Exemption Under Florida Statutes § 316.0083(1)(d)

This is a form of affidavit that you may use to establish an exemption from the statutory penalty described in the

notice of violation that you have received. Section I contains the instructions for filling out this form. Section II is

the form that you must fill out if you choose to use this form of affidavit. Please read the instructions in Section I

carefully before filling out Section II or mailing this affidavit. If this affidavit is incomplete, unsworn, does not

contain required documentation, or is not received before the due date, it will not be sufficient to establish an

exemption under § 316.0083(1)(d) necessary to avoid court fees, costs and the issuance of a Uniform Traffic

Citation.

I. Instructions

(1)

Florida Statutes § 316.0083 provides that the registered owner of a motor vehicle found by a traffic

infraction detector to have violated Florida Statutes §§ 316.074(1) or 316.075(1)(c)1, relating to

adherence to traffic control devices, is responsible for a statutory penalty of $158.00 unless the owner

establishes by affidavit that an exemption applies. The notice of violation you have received explains the

statutory exemptions and how to establish them.

(2)

Section II of this document constitutes an affidavit that you may use to assert an exemption. Please fill in

all blanks with the information requested. If you do not provide the required information, your affidavit will

not be sufficient and will not avoid payment of the penalty.

(3)

If you assert that you are exempt from the statutory penalty because, at the time of the violation described

in the notice, the vehicle was in the possession, custody, or control of another person, then you must

provide the name, address, date of birth, and, if known, the driver’s license number of the person who

leased, rented, or otherwise had care, custody, or control of the vehicle at the time of the violation.

Section II contains a space for you to do so.

(4)

If you assert that you are exempt from the statutory penalty because, at the time of the violation described

in the notice, the vehicle was stolen, then the affidavit must include a copy of a police report showing the

vehicle to have been stolen. Please attach the police report to this affidavit.

(5)

If you assert that you are exempt from the statutory penalty because a Uniform Traffic Citation was issued

by a law enforcement officer for the violation of Florida Statute § 316.074(1) or 316.075(1)(C)1 stated in

the notice, then you must include the serial number of the Uniform Traffic Citation. Section II contains a

space for you to do so.

(6)

This affidavit must be sworn to before a notary public or other person authorized to administer oaths. A

form for the notary or other person to execute is included at the end of Section II. Please do not return

this affidavit without this evidence of its being sworn, as that will not be sufficient and will not avoid

payment of the penalty.

(7)

Upon completing this affidavit, please mail it to: Orange County, c/o Intersection Safety Program, 4200 S.

John Young Py, Orlando, FL 32839.

The statements in this affidavit must be truthful. The submission of a false affidavit is a misdemeanor

(8)

of the second degree, punishable under Fla. Stat. § 775.082 or § 775.083 by a term of

imprisonment not to exceed sixty (60) days and/or a fine not to exceed $500.00.

Affidavit Establishing Exemption Under Florida Statutes 316.0083(1)(D) Form - Orange County Public Works Department

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