Copy of a police report showing the deceased owner’s registered license plate or motor vehicle was
stolen after the owner’s death but on or before the date of the alleged violation.
I have provided ______________________________ to satisfy the requirements of this section.
3. I understand that Florida Statutes § 316.0083 requires that I provide detailed information supporting
the exemption(s) I have identified in Paragraph 2, which may include the facts and circumstances
supporting the exemption I have asserted. That detailed information is as follows (attach additional
sheets as necessary):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
4. The foregoing statements are true and correct.
_____________________________________________
Signature of Registered Owner
_____________________________________________
Phone Number
_____________________________________________
Email of Registered Owner
VERIFICATION OF NOTARY OR PERSON AUTHORIZED TO ADMINISTER OATHS
STATE OF ____________________
)
)
COUNTY OF_______________ ___
)
Sworn to and subscribed before me on _________
, 20__, by ________________________, who is ____
personally known to me or ____ provided identification, and who did take an oath.
__________________
Notary Public, State of Florida
Printed Name:___
My Commission Expires:___________________
MAIL TO:
Orange County Public Works Department
4200 South John Young Parkway
Orlando, FL, 32839
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