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Get Hsmv 84061 2011-2024

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DECLARATION AFFIDAVIT FOR A MOTOR VEHICLE WHICH WILL BE TITLED AND REGISTERED IN ANOTHER STATE OR COUNTRY Date Purchaser s Signed I/we do hereby attest pursuant to section 319. 23 6 a Florida Statutes that I/we purchased a motor vehicle described as a Year Make on from Vehicle Identification Number VIN Date Complete Name of Selling Dealer responsible for applying for title and registering the vehicle in another state or country. Under penalties of perjury I declare that I have read the foregoing document and that the facts stated in it are true. Purchaser s Printed Name Purchaser s Signature Purchaser s Complete Address Co- Purchaser s Printed Name when applicable HSMV 84061 S 08/11. 23 6 a Florida Statutes that I/we purchased a motor vehicle described as a Year Make on from Vehicle Identification Number VIN Date Complete Name of Selling Dealer responsible for applying for title and registering the vehicle in another state or country. Under penalties of perjury I declare that I have read the foregoing document and that the facts stated in it are true. Under penalties of perjury I declare that I have read the foregoing document and that the facts stated in it are true. Purchaser s Printed Name Purchaser s Signature Purchaser s Complete Address Co- Purchaser s Printed Name when applicable HSMV 84061 S 08/11. 23 6 a Florida Statutes that I/we purchased a motor vehicle described as a Year Make on from Vehicle Identification Number VIN Date Complete Name of Selling Dealer responsible for applying for title and registering the vehicle in another state or country. Under penalties of perjury I declare that I have read the foregoing document and that the facts stated in it are true. Purchaser s Printed Name Purchaser s Signature Purchaser s Complete Address Co- Purchaser s Printed Name when applicable HSMV 84061 S 08/11. .

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