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APPLICATION FOR REPLACEMENT LICENSE PLATE, …

STATE OF FLORIDA. DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES MOTORIST SERVICES. SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE. 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 ) _____. HOV (High Occupancy Vehicle) Decal _____. 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).

PROCEDURES AND INSTRUCTIONS . Provision of Law: Section 320.0607, Florida Statutes, provides for the replacement of license plates and validation decals when the

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