STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTOR VEHICLES, Neil Kirkman Building - Tallahassee, FL 32399
Notice of Sale and/or Bill of Sale for a Motor Vehicle, Mobile Home,
Off-Highway Vehicle or Vessel
Notice of Sale (Seller ONLY must complete sections 1 & 3). Purchaser does not need to sign.
Bill of Sale (Seller and purchaser must complete sections 1, 2, when applicable & 3)
1. Motor Vehicle, Mobile Home, Off- Highway or Vessel Description
Certificate of Title Number Identification Number
I do hereby sell or have sold and delivered the above described motor vehicle, mobile home,
off-highw ay vehicle or vessel to:
Print Name(s) of Purchaser(s)
Address City State Zip Code
Date of Sale
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 p roviding a false statement may result in fines and/or imprisonment.
WE STATE THAT THIS MOTOR VEHICLE’S 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.
UNDER PENA LTIES OF PERJURY, I D E C L AR E T HAT I H AV E READ T H E F O R E G OI N G D O C U M E N T AN D T HAT T H E F AC T S
STATED IN IT A RE TRUE.
Seller's Printed Name Date
Seller's Ad dress City State Zip Code
Co-Seller's Signature (if applicable) Co-Seller's Printed Name (if applicable) Date
Co-Seller's Address (if applicable) City State Zip Code
Purchaser's Printed Name Date
Co-Purchaser's Signature (if applicable)
Co-Purchaser's Printed name (if 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.
HSMV 82050 (Rev. 01/06) S