Hsmv 83146 - Application For Replacement License Plate, Validation Decal Or Parking Permit
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1
2STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES
APPLICATION FOR REPLACEMENT LICENSE PLATE, VALIDATION DECAL
OR PARKING PERMIT
(Instructions on Reverse Side)
1 REPLACEMENT TYPE
REPLACEMENT REASON
:
:
Check applicable box below
Check applicable box below
License Plate
Damaged
Surrendered/Seized
Decal
Defaced
Stolen
License Plate and Decal
Lost
Disabled Person Long-Term Parking Permit
Lost-in-transit (applied for and never received)
Disabled Person Temporary Parking Permit
Voluntary (specific reason for replacement)____________
_______________________________________________
Please contact your Local County Tax Collector's Office or License Plate Agency for fee information.
2
OWNER / APPLICANT IDENTIFICATION
_______________________________________________________________________________________________________
(Owner’s Name)
(Owner’s Sex,
(Date of Birth
For company, show “C” for sex)
Or Month of Expiration)
_______________________________________________________________________________________________________
(Street Address)
_______________________________________________________________________________________________________
(City)
(State)
(Zip)
_______________________________________________________________________________________________________
(Lessee’s Name)
(Lessee’s Sex,
(Date of Birth
For company, show “C” for sex)
Or Month of Expiration)
_______________________________________________________________________________________________________
(Street Address)
_______________________________________________________________________________________________________
(City)
(State)
(Zip)
1st Owner D/L Number_________________________________________ 2nd Owner D/L Number ________________________________________________
3
VEHICLE INFORMATION
(a)
________________________________________________________________________________________________________________________________
(Vehicle Identification Number)
(Year)
(Make)
(Color)
(Type)
(Title Number)
(b)
________________________________________________________________________________________________________________________________
(Previous License Plate Number)
(Previous Decal Number)
(Previous Parking Placard Number)
4
ATTESTMENT
(CHECK WHEN APPLICABLE)
l
License Plate
Deca
Parking Permit was reported stolen to the:
Police Department or
Sheriff’s Office
I hereby certify under the penalty of perjury that the license plate, decal or permit for the vehicle listed in Section 3 (a), is no
longer or has never been in my possession for the reason checked in Section 1. All information herein is true and correct to the
best of my knowledge.
________________________________________________________________________________________________________________________________
(Owner/Applicant’s Signature)
(Date)
Complete the following, if applicable:
was surrendered to the tax collector: _____________ __________
____________________________________
(License Plate, Decal, or Parking Permit Number)
(County)
(Agency)
___________________________________________ ___________________
(Signature of Agency Personnel)
(Date)
HSMV 83146 (Rev. 11/04) S
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