Transcription of DECLARATION AFFIDAVIT FOR A MOTOR VEHICLE …
1 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 (6)(a), Florida Statutes, that I/we purchased a MOTOR VEHICLE described as a: _____, _____, (Year) (Make) _____, on _____, from VEHICLE Identification Number (VIN) (Date) _____, and further declare that I/we will be (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) Co-Purchaser s Signature (when applicable) _____ Co-Purchaser s Complete Address (when applicable) HSMV 84061 S (08/11)
