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STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY …

STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE APPLICATION FOR AN ORIGINAL/DUPLICATE DERELICT MOTOR vehicle CERTIFICATE AND REQUEST TO CANCEL TITLE This form must be used by the owner/seller of a derelict motor vehicle /trailer who is arranging for the delivery and/or sale of the derelict motor vehicle /trailer to a licensed salvage motor vehicle dealer or a registered secondary metals recycler when the title, salvage title or certificate of destruction is not available. The derelict motor vehicle must be worth less than $1,000 or the derelict trailer (TL) must be worth less than $5,000 and must be at least ten model years old (count model year as year one). This form may also be used to apply for a duplicate Derelict Certificate.

I am notifying the Florida Department of Highway Safety and Moto r Vehicles, as required by law, within 24 hrs. (excluding weekends/holidays) of receiving the derelict motor vehicle/trailer by delivering this completed form to a tax collector's office/license plate agency.

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STATE OF FLORIDA DEPARTMENT OF HIGHWAY …

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