Untitled Document

MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT

STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES

(Instructions on Reverse Side)

This reassignment is supplement to: Title No.: State of Issue:

Manufacturer's Statement or Certificate of Origin

Is the title electronic? Yes No

VEHICLE DESCRIPTION

REASSIGNMENT INFORMATION

Name of Seller(s)/Agent (Print)

ODOMETER DISCLOSURE STATEMENT

WARNING: FEDERAL AND STATE LAW REQUIRE THAT YOU STATE THE ODOMETER MILEAGE IN CONNECTION WITH TRANSFER OF OWNERSHIP. FAILURE TO COMPLETE OR PROVIDING A FALSE STATEMENT MAY RESULT IN FINES AND/OR IMPRISONMENT.

I/WE STATE THAT THIS DIGIT ODOMETER NOW READS, XX (NO TENTHS) MILES, DATE READ AND I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE ODOMETER READING.

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

NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS ASSIGNMENT AND ALL ASSIGNMENTS THAT FOLLOW.

ORIGINAL: SUBMIT WITH APPLICATION FOR TITLE     COPY: SELLER/DEALER RETAIN IN FILE

HSMV 82994 (REV. 04/14) S

WHEN SHOULD THIS FORM BE USED?

FORM HSMV 82994, MOTOR VEHICLE TITLE REASSIGNMENT SUPPLEMENT, MUST BE USED:

1. with conforming Florida Certificate(s) of Title to make additional dealer reassignments and odometer disclosures when all reassignment and odometer disclosure spaces on the reverse side of the Certificate of Title have been used;

Or

2. with a non-conforming Certificate(s) of Title to make reassignments and odometer disclosures;

Or

3. with conforming MCO, when the MCO is not available at the time of sale;

Or

4. with all out-of-state non-conforming Certificate(s) of Title to make dealer reassignments and odometer disclosures;

Or

5. when ownership is being transferred on an Electronic Certificate(s) of Title.

NOTE: This form is required when transferring ownership on a Vehicle Certificate of Title that is NOT electronic; the "Transfer of Title By Seller" section must be completed by the seller(s)/agent.

FILING:

1. The original HSMV 82994 is to be surrendered with the application for title.

2. The copy of the HSMV 82994 is to be retained by the dealer in his/her records for a period of five (5) years. It is recommended that the individual seller(s) retain a copy of this form for their records.