Notice of Sale And/or Bill of Sale For A Motor Vehicle, Mobile Home, Off-Highway Vehicle or Vessel

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STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES - DIVISION OF MOTORIST SERVICES



SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
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Notice of Sale and/or Bill of Sale for a Motor Vehicle,
Mobile Home, Off-Highway Vehicle or Vessel
Notice of Sale (Seller must complete sections 1 & 3). The purchasers signature in section 3 is optional.
Bill of Sale (Seller and purchaser must complete sections 1, 2 (when applicable) & 3).

1. Motor Vehicle, Mobile Home, Off- Highway or Vessel Description

Year



Make/Manufacturer

Body Type

Model

Color
Certificate of Title Number Vehicle/Vessel Identification Number



I/we do hereby sell or have sold and delivered the above described motor vehicle, mobile home,
off-highway vehicle or vessel to:

Print Name(s) of Purchaser(s)

Address City State Zip Code


Date of Sale

Selling price
$
2. Odometer Disclosure Statement (Required For a Motor Vehicle)
Federal and State law requires that you state the mileage in connection with the transfer of ownership. Failure to
complete or providing a false statement may result in fines and/or imprisonment.
WE STATE THAT THIS MOTOR VEHICLES 5 DIGIT OR 6 DIGIT ODOMETER NOW READS , . xx

(NO TENTHS) MILES, DATE READ ________/________/________, AND WE HEREBY CERTIFY THAT TO THE BEST OF OUR KNOWLEDGE

THE ODOMETER READING:
1. REFLECTS THE ACTUAL MILEAGE. 2. IS IN EXCESS OF ITS MECHANICAL LIMITS. 3. IS NOT THE ACTUAL MILEAGE.


Affidavit (When applicable):



3.

Certification


UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS
STATED IN IT ARE TRUE.
Seller's Signature


Seller's Printed Name Date
Seller's Address City State Zip Code


Co-Seller's Signature (when applicable) Co-Seller's Printed Name (when applicable) Date
Co-Seller's Address (when applicable) City State Zip Code


Purchaser's Signature


Purchaser's Printed Name Date
Co-Purchaser's Signature (when applicable)


Co-Purchaser's Printed name (when applicable) Date

OWNERSHIP STATUS FOR THE ABOVE DESCRIBED MOTOR VEHICLE, MOBILE HOME, OFF-HIGHWAY VEHICLE OR VESSEL
WILL NOT CHANGE UNTIL THE PURCHASER APPLIES FOR AND IS ISSUED A CERTIFICATE OF TITLE.

Check your local phone book government pages or visit the following website for current mailing
addresses: http://www.flhsmv.gov/offices/
HSMV 82050 (Rev. 06/11) S

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