STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES STATEMENT OF BUILDER REBUILT ASPT SECTION I. 550.8 355.439 m (CITY)Tj S 281.52 516.719 l S S 503.28 555.36 m 45.119 584.16 l 192.24 273.6 11.04 11.279 re 242 1 0000148104 00000 n S (Page 2)Tj (THE MOTOR VEHICLE, MOTORCYCLE, OR MOBILE HOME HAS BEEN OMITTED. S 47.52 310.966 m 93 Tz 50.162 0 Td 196 1 0000145619 00000 n S 0000053990 00000 n 0000020222 00000 n 280.8 331.92 m 0000136040 00000 n 95 Tz -46.8 -15.585 Td BT Driver Services Forms. (Component Parts Marked)Tj (\()Tj S 0 g 342.24 485.254 Td S 0000000173 00000 n residents of florida and all vessel owners, residing in florida or out of state, should submit this form and all required documentation to a local florida tax COLLECTOR’S OFFICE OR THE FLORIDA TAX COLLECTOR'S OFFICE LOCATED IN THE APPLICANT'S COUNTY OF RESIDENCE FOR PROCESSING. S S -2.4 -36.479 Td 0 g 550.318 91.919 m 90 Tz 118.8 -28.08 Td 332.64 377.28 l 46.559 717.12 507.359 18 re 413.762 398.88 m 94 Tz 286.322 -39.362 Td 554.4 742.799 l (Yes)Tj 96 Tz -113.04 -0.24 Td 0000023799 00000 n (D-4-)Tj (Region #-)Tj (Replacement VIN Plate/Decal)Tj BT 0 g /ZaDb 14 Tf 1 0 0 1 -0.391 0.797 Tm (4) Tj ET endstream endobj 190 0 obj << /Resources << /ProcSet [ /PDF /Text ] /Font << /ZaDb 93 0 R >> >> /BBox [ 0 0 11 11 ] /MK << /CA (4)>> /Length 55 >> stream 98 Tz -215.039 0 Td 0000011634 00000 n 95 Tz -46.8 -15.585 Td /TT29 10 Tf ET 554.4 742.799 l 0000077306 00000 n 107 Tz 221.76 463.654 Td (No)Tj 98 Tz -215.039 0 Td 98 Tz -215.039 0 Td 332.64 377.28 l 0000047242 00000 n 99 Tz 378.24 81.094 Td 95 Tz -46.8 -15.585 Td S 243.119 255.362 11.04 11.279 re (SECTION IV. (Yes)Tj S 0000053496 00000 n 140.64 555.12 m ET Use the navigation tabs below to view more forms. S 97 Tz 259.44 -22.334 Td (SECTION III. 551.279 555.36 m 0000014877 00000 n 551.04 254.88 m BT S (Reset) Tj /TT16 10 Tf 0000018864 00000 n 551.52 613.68 m 0000140291 00000 n 441.839 517.439 m /TT5 10 Tf (Year:)Tj 93 Tz 50.162 0 Td (Component Parts Marked)Tj (VIN:)Tj /TT28 10 Tf 280.8 354.48 m Title Information and Shipping. 0000050048 00000 n 98 Tz 71.042 -0.238 Td (D-2-)Tj (UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOC\ UMENT)Tj Motor Vehicle/Motorcycle is complete and in road operable condition.) OmniForm S S 191.999 228.48 11.04 11.279 re S 191.999 228.48 11.04 11.279 re 0 G california dmv release of liability form pdf Employee to check your credit periodically. 0000022032 00000 n 0000131509 00000 n 0000014325 00000 n (CITY)Tj 550.8 421.2 m /TT12 10 Tf 0000017506 00000 n 281.758 612 m 0000013258 00000 n 65.76 420.959 l Comments and Help with florida rebuilt title application, Rate free state of florida hsmv 84490 form, Keywords relevant to statement builder form, Related Features 0000016005 00000 n S 1 w /TT0 10 Tf 437.04 332.64 m (Secondary VIN Verified)Tj /TT20 10 Tf 280.8 354.48 m 21.6 0 Td Q endstream endobj 232 0 obj << /Type /Annot /Rect [ 375.95407 -81.4274 475.95407 18.5726 ] /NM (19000e8) /F 4 /Subtype /FreeText /M (D:20030409090449-04'00') /DA ([1 1 1] rg /Helv 12 Tf) /BS 233 0 R /T (Dkinsey) /P 108 0 R /C [ 1 1 1 ] /AP << /N 234 0 R >> >> endobj 233 0 obj << /W 0 >> endobj 234 0 obj << /Length 60 /Type /XObject /Subtype /Form /FormType 1 /BBox [ -0.00015 -0.00015 100.00015 100.00015 ] /Matrix [ 1 0 0 1 0.00015 0.00015 ] /Resources << /ProcSet [ /PDF /Text ] /Font << /Helv 199 0 R >> >> >> stream (With Tongue)Tj !UU'd'`"FkikllGToC!j+e[&MV9UX3%46?4*4q$XYY*"__hTPqG/=uehhjpuZ!FCf]jWEJHM$N$5gHT%g+Es?qB>c$8]l8D&@.0\AmEFGlIVg/W-[j]?I1DV,+!IhJ1nK,a\1E2Xj;[!9(9gdjeE-PYlX9.aLRj0"e8(_7"5?=k46nE"')O\T"OJ. 0000058609 00000 n 94 Tz -258.72 -0.24 Td /TT20 10 Tf (NICB Check)Tj (VIN:)Tj 164.398 -0.24 Td 281.52 555.12 m S 551.04 499.2 l 551.282 584.399 m 281.04 420.959 m 78 688.56 l 46.559 717.12 507.359 18 re (No)Tj 0000049019 00000 n 84490: Statement of Builder. (Inspector's Badge ID Number)Tj BT 551.04 499.2 l 98 Tz -215.52 -18 Td (\))Tj S 0000007030 00000 n /TT20 10 Tf 96 Tz 374.879 -22.56 Td S S (Title State:)Tj 96 Tz -259.682 -0.24 Td /TT13 10 Tf 0000051978 00000 n (Component Parts Marked)Tj 281.52 516.719 l 46.08 742.799 m /TT25 10 Tf (D-2-)Tj 425.76 191.04 11.04 11.279 re 0000131970 00000 n BT )Tj 1 w (ZIP)Tj Property Tax Forms. 0000043109 00000 n 98 Tz -3.12 -48.478 Td 425.76 191.04 11.04 11.279 re (Make:)Tj 1 i /RelativeColorimetric ri (Without Tongue)Tj (STREET ADDRESS)Tj 98 Tz -284.64 -0.24 Td 0000080076 00000 n 94 Tz -258.72 -0.24 Td S 44.64 -27.119 Td S 411.659 517.606 Td 0000000264 00000 n 414 354.24 m 0000018562 00000 n 503.52 236.4 11.04 11.279 re 550.8 169.328 m 0000013858 00000 n 96 Tz 383.522 15.106 Td 2003-01-10T10:30:46-05:00 /TT4 10 Tf S ET 65.52 354.48 l -0.479 -22.32 Td 2016-09-08: Sep 8, 2016: DMV and MVED: Form: Current: This website is provided for general guidance only. 334.08 354.24 l 303.12 192.002 11.04 11.279 re S S -164.88 0 Td ET 45 155.517 l 456 291.84 11.04 11.279 re 43.92 54 l /TT16 10 Tf (No)Tj 85 Tz -92.4 -30.96 Td (Secondary VIN Verified)Tj S 358.08 398.88 l 0000046037 00000 n 0000147614 00000 n 95 Tz -46.8 -15.585 Td -2.4 -36.479 Td 99 Tz 378.24 81.094 Td 242.64 228.722 11.04 11.279 re (HSMV 84490 S \(Rev. 258.72 54 m 363.359 208.8 m 469.919 398.88 l S (Make:)Tj -0.479 -22.32 Td 551.52 613.68 m 98 Tz 286.8 0 Td endstream endobj 222 0 obj 5630 endobj 223 0 obj << /Type /Metadata /Subtype /XML /Length 866 >> stream (Year:)Tj BT 0 g /ZaDb 14 Tf 1 0 0 1 -0.391 0.797 Tm (4) Tj ET endstream endobj 189 0 obj << /Resources << /ProcSet [ /PDF /Text ] /Font << /ZaDb 93 0 R >> >> /BBox [ 0 0 11 11 ] /MK << /CA (4)>> /Length 55 >> stream ET 106 Tz -0.72 -12.719 Td 2003-04-09T09:05:31-03:00 (Vehicle Painted Prior)Tj 15 1 0000076703 00000 n 550.8 155.517 m S ET Q endstream endobj 226 0 obj << /Length 109 /Subtype /Form /BBox [ 0 0 72 18 ] /Resources << /ProcSet [ /PDF /Text ] /Font << /HeBo 177 0 R >> >> >> stream -115.92 0 Td 0000141741 00001 n (AND THAT THE FACTS PROVIDED HEREIN ARE TRUE. (Body:)Tj S 97 Tz 138.96 721.653 Td (Component Parts Marked)Tj S Yes, if it is not performed by … S 551.52 613.68 m 0000000363 00000 n 95 Tz 395.039 0 Td 452.16 377.28 l 0000044809 00000 n 303.12 192.002 11.04 11.279 re (PRINTED NAME OF APPLICANT/BUSINESS)Tj 46.08 742.799 m S 95 Tz 375.12 -22.079 Td (Vehicle Painted Prior)Tj -274.802 0 Td BT 91 Tz 74.4 0 Td (Tax Due On:)Tj (Yes)Tj -394.322 -0.72 Td 503.28 555.36 m How about the manual for a driver license? S ET 98 Tz -188.402 0 Td 43.92 54 l (and completed Section IV based on that inspection. Available for PC, iOS and Android. S S 44.16 142.8 l Official Website Florida Department of Highway Safety and Motor ... Forms / Applications / Checklists / Guidelines - Miami-Dade County, Davie, Florida - Downloadable Forms - the Town of Davie. You must report a change of address to DMV within 10 days of the change. applicant information and signature date: under penalties of perjury, i declare that i have read the foregoing document and that the facts provided herein are true. 328.079 91.919 l S S (Federal Decal Intact)Tj 0000014778 00000 n 24.242 0 Td 144 2 0000134149 00000 n ET 0000047681 00000 n 394.8 -17.52 Td 0000138754 00000 n S 90 Tz -259.438 0 Td S 45 155.517 l 98 Tz -215.52 -18 Td 164.398 -0.24 Td (SECTION IV. 98 Tz 71.042 -0.238 Td endstream endobj 238 1 obj << /Length 109 /Subtype /Form /BBox [ 0 0 72 18 ] /Resources << /ProcSet [ /PDF /Text ] /Font << /HeBo 177 0 R >> >> >> stream APPLICANT INFORMATION AND SIGNATURE) Tj -92.4 -30.96 Td 85 Tz (Date:) Tj /F0 10 Tf -0.238 -25.679 Td 107 Tz (UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT) Tj -0.72 -12.719 Td 106 Tz (AND THAT THE FACTS PROVIDED HEREIN ARE TRUE. 551.038 517.439 l 98 Tz -188.402 0 Td (TELEPHONE NUMBER:)Tj /TT16 10 Tf Hsmv 84490 0000049228 00000 n Tj /F0 12 Tf 23.04 -26.402 Td 87 Tz (SECTION 11. 90 Tz 118.8 -28.08 Td Attach the original MSO, bill of sale(s), or receipt(s) for all major component parts (must contain. 180.96 516.719 m S (Inspector's Badge ID Number)Tj (Under penalties of perjury, I declare that I have made inspection of thi\ s motor vehicle, motorcycle, or mobile home)Tj 414 354.24 m 45 155.517 l S (Replacement VIN Plate/Decal)Tj (Yes)Tj S (SIGNATURE OF APPLICANT/BUSINESS)Tj 425.76 191.04 11.04 11.279 re 363.359 208.8 m 408.48 377.28 m (Under penalties of perjury, I declare that I have made inspection of thi\ s motor vehicle, motorcycle, or mobile home)Tj (STATE)Tj 46.08 742.799 m 93 Tz 50.4 0 Td 304.08 584.399 l 281.52 516.719 l S 412.08 555.36 l S -264.002 -0.24 Td 551.282 584.399 m S 412.08 555.36 m S 342.24 485.254 Td 281.52 584.16 m 96 Tz -259.682 -0.24 Td (STATE)Tj 0000058397 00000 n S 0.75 w (CITY)Tj 8 1 0000076354 00000 n (Signature of Inspector)Tj 140.64 555.12 m BT Signature of Inspector SECTION V. K&&/ USE ONLY SECTION IV. Change "Show entries" to a higher amount. S 98 Tz -188.402 0 Td (With Tongue)Tj /HeBo 12 Tf S 550.8 398.88 m /TT24 10 Tf form HSMV 84491. 1 g 503.28 555.36 l S 19 3 0000068414 00000 n 93 Tz 50.4 0 Td 328.079 91.919 l (SECTION III. (Color:)Tj 97 Tz -272.398 -19.202 Td 229.68 555.12 m BT S 0000139020 00000 n BT 0 g /ZaDb 13 Tf 1 0 0 1 -0.329 0.782 Tm (4) Tj ET endstream endobj 95 0 obj << /Resources << /ProcSet [ /PDF /Text ] /Font << /ZaDb 93 0 R >> >> /BBox [ 0 0 10 11 ] /MK << /CA (4)>> /Length 55 >> stream (SIGNATURE OF APPLICANT/BUSINESS)Tj 14.2798 TL 90 Tz -259.2 0 Td )Tj 160 2 0000072507 00000 n Your use of this site is subject to Terms of Service and Privacy Policy, pdfFiller is not affiliated with any government organization. -2.4 -36.479 Td 0000056701 00000 n 65.76 398.88 l (This ASPT/Vehicle resembles a:)Tj 104.4 169.328 l 45.36 457.92 508.079 18 re S 98 Tz -215.52 -18 Td 242.64 228.722 11.04 11.279 re 44.88 499.92 m 0000145158 00000 n 97 Tz 424.8 -0.24 Td (Previous Rebuilt Title)Tj S 0.75 w 0 G 1 w 0.5 0.5 71 17 re s q 1 1 70 16 re W n 0 g BT 550.8 398.88 m ... DMV verifies trailers with an unladen weight of 6,000 pounds or less. 229.68 555.12 l (Odometer:)Tj 0000020976 00000 n 95 Tz 395.039 0 Td 551.282 584.399 m 304.319 613.68 l 550.8 155.517 m S S 45.119 612 l This form is used to register vehicles for the first time and for out of state vehicles. 95 Tz 395.039 0 Td S 437.04 332.64 m (Vehicle Painted Prior)Tj (CITY)Tj (\()Tj 0 G 1 w 0.5 0.5 71 17 re s q 1 1 70 16 re W n 0 g BT 100 Tz 149.698 517.606 Td /TT24 10 Tf 304.319 613.68 l 97 Tz -50.4 0 Td OmniForm Converter for PDF 99 Tz 47.52 312.214 Td If a birth certificate is needed for a DMV transaction, our offices are able to print them for you. (HSMV 84490 S \(Rev.\))Tj 44.88 555.12 l 229.68 555.12 l S 65.76 377.28 l 281.52 516.719 l 4 /1. 0000055162 00000 n )Tj S 243.119 273.84 11.04 11.279 re 414 354.24 m (Yes)Tj 192.24 255.362 11.04 11.279 re (PRINTED NAME OF CO-APPLICANT/BUSINESS)Tj DMV USE ONLY)Tj (No)Tj 0000057761 00000 n ET 550.32 53.759 m 0000050361 00000 n -164.88 0 Td 0000132179 00000 n Signature HSMV 84490 Rev. (D-3-)Tj S 192.24 255.362 11.04 11.279 re (Reset) Tj (THE MOTOR VEHICLE, MOTORCYCLE, OR MOBILE HOME HAS BEEN OMITTED. 24.242 0 Td 281.758 612 m S 105 Tz 0.238 -12.719 Td This form must be filled out completely and submitted in-person at a CSC location. 487.68 332.16 l 0000112039 00000 n S. Sandra96. 358.08 398.88 l S (UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOC\ UMENT)Tj (No)Tj (Yes)Tj 437.04 332.64 m 163 2 0000081965 00000 n 281.04 398.88 m (Component Parts Marked)Tj 550.318 91.919 m 455.76 236.4 11.04 11.279 re (THE MOTOR VEHICLE, MOTORCYCLE, OR MOBILE HOME HAS BEEN OMITTED. A completed 82040 should be submitted with every title you give to us for processing. Other parties need to complete fields in the document. 0000013113 00000 n 0000020674 00000 n Number of Receipts: HSMV 84490 (Rev. 304.08 555.36 l 281.52 584.16 m 44.64 -27.119 Td /TT29 10 Tf 144 2 0000079445 00000 n (Inspector's Badge ID Number)Tj 140.64 555.12 l (This ASPT/Vehicle resembles a:)Tj (Please mark the appropriate answer:)Tj Welcome to the Indiana Bureau of Motor Vehicles! (This ASPT/Vehicle resembles a:)Tj 281.04 420.959 m 550.318 91.919 m 0 86.1281 Td 111 1 0000079254 00000 n S Completed 21 July 2020 96 Tz 258.48 -25.2 Td )Tj (This ASPT/Vehicle resembles a:)Tj 93 Tz 50.159 0 Td 95 Tz 375.12 -22.079 Td BT 97 Tz 372.96 -22.079 Td When you are issued a parking, photo enforcement, or minor moving violation ticket in the District of Columbia, you have three options to respond to the ticket, according to DC law: pay it, admit with an explanation, or contest it. (STATEMENT OF BUILDER FORM HSMV 84490)Tj S 96 Tz 383.522 15.106 Td 0000061099 00000 n Present this form, a social security card (if you have been issued one), and proof of identity satisfactory to the Department of Highway Safety and Motor Vehicles, if under 18 years of age. 0000011327 00000 n S (No)Tj (No)Tj CAPTCHA. 78 688.56 l /Helv 12 Tf 0 w 46.559 717.12 507.359 18 re 44.16 142.8 l (STREET ADDRESS)Tj 209.273 310.966 l 94 Tz -258.72 -0.24 Td is not the form you're looking for? 281.758 612 m 304.08 555.36 l 0000076263 00000 n S Compare Search ( Please select at least 2 keywords ) Most Searched Keywords. 455.76 236.4 11.04 11.279 re 0000018411 00000 n (Tax Due On:)Tj 97 Tz 138.96 721.653 Td (or)Tj /TT4 10 Tf 304.08 584.399 l 0 -18.24 TD (TELEPHONE NUMBER:)Tj 0000082176 00000 n (Audit #-)Tj 99 Tz 378.24 81.094 Td S 0000022781 00000 n 96 Tz -113.04 -0.24 Td If you need to obtain your driving record, that information is here as well. 1 w 0 G 1 w 0.5 0.5 71 17 re s BT 0 g /HeBo 12 Tf 1 0 0 1 18 4 Tm (Reset) Tj ET endstream endobj 179 0 obj << /Type /Action /S /ResetForm >> endobj 180 0 obj << /Resources << /ProcSet [ /PDF /Text ] /Font << /ZaDb 93 0 R >> >> /BBox [ 0 0 11 11 ] /MK << /CA (4)>> /Length 55 >> stream (Comments:)Tj 281.52 555.12 m 107 Tz -0.238 -25.679 Td 0000044955 00000 n 0000089250 00000 n S S 0.75 w 193.68 688.56 m 97 Tz 5.519 -9.119 Td 0000051096 00000 n -0.479 -22.32 Td /TT4 10 Tf BT BT S S (SECTION IV. (Title Number:)Tj If you live in the Orlando area you know the local DMV offices can be very busy. 24.242 0 Td 0000045249 00000 n S (SIGNATURE OF APPLICANT/BUSINESS)Tj 65.52 354.48 l 97 Tz 5.519 -9.119 Td S 1 i S ET trailer << /Size 203 /Info 1 0 R /Root 2 0 R /ID[<70a17dbcdd4f8a1d0c9a33fcf8e2bd79><70a17dbcdd4f8a1d0c9a33fcf8e2bd79>] >> startxref 63440 %%EOF 1 0 obj << /Producer (OmniForm Converter for PDF) /Creator (OmniForm) /ModDate (D:20030110105329-05'00') /CreationDate (D:20030110103046-05'00') >> endobj 2 0 obj << /Type /Catalog /Pages 3 0 R /AcroForm 196 0 R /Metadata 203 0 R >> endobj 4 1 obj << /Length 109 /Subtype /Form /BBox [ 0 0 72 18 ] /Resources << /ProcSet [ /PDF /Text ] /Font << /HeBo 177 0 R >> >> >> stream 21.6 0 Td (\))Tj (Reset) Tj 0 G 1 w 0.5 0.5 71 17 re s q 1 1 70 16 re W n 0 g BT S 92 Tz -163.44 0 Td 358.08 398.88 l 0000016154 00000 n 0000055429 00000 n 551.04 499.2 l (D-1 -)Tj 0000054305 00000 n (D-3-)Tj 0000078650 00000 n 281.52 499.92 l /TT7 9 Tf 108 1 0000147705 00000 n 160 2 0000136249 00000 n 44.64 -27.119 Td 550.8 355.439 m 411.659 517.606 Td BT (Please mark the appropriate answer:)Tj S BT S (Page 2)Tj (NICB Check)Tj S 551.04 254.88 m S ET 243.119 292.082 11.04 11.279 re 24 3 0000069049 00000 n 97 Tz -272.398 -19.202 Td 281.04 398.88 m /TT4 10 Tf 551.04 254.88 m This form is used by (1) learning drivers age 18 who hold a learner’s permit, (2) learning drivers age 19 and older who hold a learner’s permit but have not completed a Virginia approved driver training course, and (3) qualifying home-schooled students to verify the observation and completion of safe driving maneuvers before applying to take the road skills test at DMV. (Yes)Tj 192.24 255.362 11.04 11.279 re 2003-04-09T09:06:16-03:00 0 g 90 Tz 118.8 -28.08 Td f (SIGNATURE OF APPLICANT/BUSINESS)Tj 98 Tz -75.362 -0.238 Td 0000025419 00000 n 413.762 398.88 m CDL Vision Exemption Form (197.25 KB) CDL Vision Exemption Form to be exempted from Federal CDL Vision Requirements. S (Yes)Tj (Yes)Tj (This ASPT/Vehicle resembles a:)Tj S S S (Mobile Home Use Only: Mobile Home was measured)Tj (Comments:)Tj 304.08 555.36 l 0 -18.24 TD -264.002 -0.24 Td (Yes)Tj 90 Tz -259.438 0 Td 280.8 331.92 m (SIGNATURE OF APPLICANT/BUSINESS)Tj (Color:)Tj 107 Tz 221.76 463.654 Td 229.68 555.12 m BT 411.659 517.606 Td S (No)Tj (SECTION III. 6) Year Make Identification Number Color Body. 281.04 377.28 m (STATEMENT OF BUILDER FORM HSMV 84490)Tj 43.92 92.16 m BT S (Yes)Tj 1 i S 180.96 516.719 m S 229.68 555.12 l 97 Tz -272.398 -19.202 Td 164.398 -0.24 Td ET David Cas Swedelson #84490 License Status: Active Address: SwedelsonGottlieb, 11900 W Olympic Blvd Ste 700, Los Angeles, CA 90064 0 g Complete Florida Form Hsmv 84490 online with US Legal Forms. 44.16 142.8 l 258.72 54 m 44.88 499.92 m 243.119 255.362 11.04 11.279 re 0000141137 00001 n /TT20 10 Tf 97 Tz -474.959 -17.759 Td 45.119 584.16 l (Yes)Tj 97 Tz -474.959 -17.759 Td 0000067658 00000 n (No)Tj S 96 Tz 383.522 15.106 Td University Wide Health And Safety Committee Meeting Minutes ... Untitled - Occupational Health and Safety, Rosie Hare, Executive Assistant, Office of VP Administration and Finan, Greg Deveau, Manager, Technology Consulting, Tech Services, AUPAT Rep, April - Occupational Health and Safety - Acadia University. S 1 i (No)Tj /TT8 12 Tf (STATEMENT OF BUILDER FORM HSMV 84490)Tj 0.75 w 0000135620 00000 n 550.562 332.16 m /TT28 10 Tf (NICB Check)Tj 363.359 208.8 m (SIGNATURE OF APPLICANT/BUSINESS)Tj /TT20 10 Tf 412.08 555.36 l 411.659 517.606 Td 342.96 332.64 l 0000062449 00000 n 550.8 421.2 m 192.24 255.362 11.04 11.279 re endstream endobj 212 0 obj 5617 endobj 213 0 obj << /Length 214 0 R >> stream (AND THAT THE FACTS PROVIDED HEREIN ARE TRUE. (Date:)Tj S -260.16 0 Td 193.68 688.56 m (Please mark the appropriate answer:)Tj -164.88 0 Td Affiliation/address . 281.04 420.959 m (\))Tj 0000047392 00000 n S (Reset) Tj 98 Tz -75.362 -0.238 Td 1 w 10 M 0 j 2 J []0 d 368.16 421.2 l (Yes)Tj S S Name . 209.273 310.966 l S S 108 1 0000133750 00000 n 0000000000 00001 f BT (Date)Tj 44.88 499.92 m S S 97 Tz -272.398 -19.202 Td Signature HSMV 84490 Rev. 408.48 377.28 m (No)Tj View, download and print fillable Hsmv 84491 - Additional Sheet To Statement Of Builder - Florida Department Of Highway Safety And Motor Vehicles in PDF format online. 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Of Revenue, find information about Motor vehicle Safety Standards HIGHWAY Trust.! ) School Enrollment form ( 197.25 KB ) CDL Vision Exemption form ( 197.25 KB ) School form. Judgment was not entered `` Show entries '' to a DMV office edit, and sign them of state.... Licensing services and taxation and collection services for the purchaser 84490 S (...