Moving to Florida

Completed ‘Personal Information Section’

Completed Driver License Application

Completed Certificate of Title

Copy of Driver License

Copy of Florida Insurance Card

Current Registration

‘Part A’ of VIN Verification

Lending Institution Info (if applicable)

PERSONAL INFORMATION SECTIONVehicle Owner Name Phone Number

Mailing Address

REQUIRED DOCUMENTS CHECKLIST:

You must have Florida insurance to obtain vehicle registration in Florida

Homeowners: Don’t forget

to file for homestead with

Property Appraiser 352-253-2150

David W. Jordan Lake County Tax Collector P.O. Box 268 Tavares, FL 32778 352-343-9602 laketax.com

A. Do you own your vehicle (not leasing or financing)?

B. Are you financing your vehicle?

C. Are you leasing your vehicle?

1 Complete ‘Personal Information Section’ (first page).

2 Complete ‘Part A’ on the VIN Verification form (next page).

3 Complete Driver License and ID card Application.

4 Return this packet along with the Required Documents to the Tax Collector’s office.

5 Payment and location information (last page)

6 The Tax Collector’s office will contact you to schedule a driver license appointment.

1 Complete ‘Personal Information Section’ (first page).

2 Provide your current registration.

3 Complete Driver License and ID card Application.

4 If title is held by a lending institution, provide name, address and account number

for lienholder.

5 Complete ‘Part A’ on the VIN Verification form (next page).

6 Return this packet along with the Required Documents to the Tax Collector’s office.

7 Payment and location information (last page)

8 The Tax Collector’s office will contact you to schedule a driver license appointment.

1 Complete ‘Personal Information Section’ (first page).

2 Provide lease agreement.

3 Provide current registration.

4 Complete Driver License and ID card Application.

5 Complete ‘Part A’ VIN Verification form (next page).

6 Return this packet along with the Required Documents to the Tax Collector’s office.

7 Payment and location information (last page)

8 The Tax Collector’s office will contact you to schedule a driver license appointment.

For information on fees go to: www.flhsmv.gov/fees/

Fl

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www.flhsmv.gov/offices/

VEHICLE IDENTIFICATION NUMBER AND ODOMETER VERIFICATION

PART A - OWNER’S VEHICLE IDENTIFICATION AFFIDAVIT AND ODOMETER DECLARATION (Completion of this part requires a physical inspection of the vehicle by the owner)

AFFIDAVIT: DATE:

This is to certify that I, the undersigned, am the lawful owner of the motor vehicle described on this form and that I have, on the date entered above, made a physical inspection of the motor vehicle and have recorded the vehicle identification number and other identification information and the odometer reading and certification in the spaces provided on this form.

VEHICLE IDENTIFICATION (MOTOR NUMBER ALL MAKES THROUGH 1954 - IDENTIFICATION NUMBER 1955 AND LATER)

Vehicle Identification Number Year Make Color Body Previous State Vehicle Titled In

ODOMETER DECLARATION

WARNING: Federal and State law require that you state the mileage in connection with an application for a

Certificate of Title. Failure to complete or providing a false statement may result in fines and/or imprisonment.

I /WE STATE THAT THIS 5 OR 6 DIGIT ODOMETER NOW READS , .XX (NO TENTHS)

MILES, DATE READ / / AND I/WE HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE

THE ODOMETER READING:

1. reflects ACTUAL MILEAGE. 2. is IN EXCESS OF ITS MECHANICAL LIMITS. 3. is NOT THE ACTUAL MILEAGE.

UNDER PENALTY OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING

DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.

(Owner’s Signature) (Owner’s Printed Name)

PART B – VERIFICATION OF THE VEHICLE IDENTIFICATION NUMBER

This section requires a physical inspection and a verification of the vehicle identification number (VIN) (or the motor number for motor vehicles manufactured prior to 1955) of the motor vehicle described on this form by a Florida Notary Public, Licensed Dealer, Police Officer, or Florida Division of Motorist Services Employee or Tax Collector Employee. If an out-of-state motor vehicle dealer verifies the VIN, the verification must be submitted on their letterhead stationery. Complete this section on all used motor vehicles, including trailers, (with abbreviation of “TL” with a weight of 2,000 pounds or more) not currently titled in Florida.

I, the undersigned, certify that I have physically inspected the above described vehicle and find that the vehicle identification number on the vehicle to be identical to the vehicle identification number recorded on this form.

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

Date: (Seal)

Commissioned Name of Florida Notary: Notary’s Signature: (Print, Type or Stamp)

If other than a Notary, check the box below that applies, and sign and complete the corresponding fields. Verified by:

Florida Compliance Examiner/Inspector(DMS/TC Employee) Law Enforcement Officer Florida Licensed Dealer

Signature: Printed Name:

Florida Compliance Examiner/Inspector Name: Badge or ID #:

Law Enforcement Agency Name: LEO Badge #:

Florida Dealer Name: Florida Dealer #:

◆ NOTICE: ANY ALTERATION OR ERASURE MAY VOID THIS DOCUMENT ♦

HSMV 82042 (REV. 06/19) www.flhsmv.gov

OFF

ICE O

F THE TAX COLLECT

OR

L A K E COU N T Y

LAKE COUNTY TAX COLLECTOR

DRIVER LICENSE & ID CARD APPLICATION

OFFICE HOURS & LOCATIONS

PG 1 of 2LCTC Rev. 04/20

PLEASE CONTINUE TO PAGE 2

OFFICE USE ONLY BELOW THIS LINE

FEDERAL REAL ID REQUIREMENTS FOR IDENTITY VERIFICATION (ALL TRANSACTIONS)

The Federal Real ID Act requires documentation that establishes your identity when applying for a Florida driver license or ID card. A STAR on your Florida driver license or ID card means you are Real ID compliant. • CURRENT FLORIDA DRIVER LICENSE OR ID CARD WITH STAR:

• FIRST TIME FLORIDA LICENSE OR ID CARD • CURRENT FLORIDA LICENSES OR ID CARDS WITHOUT A STAR (Customers born on or before 1945 that cannot obtain a birth certificate may present a secondary identification)

• YOUR NAME HAS CHANGED FROM YOUR BIRTH CERTIFICATE NAME (See Box #2 below)

Address Change Name Change• Bring two proofs of your new address (see Box #3 below) • Bring your official name change document (see Box #2 below)

Date of TLSAE Completion: Vision: Pass/Fail Date:Restrictions:

Transaction Processed: Driver License ID Card Reinstatement Only Temporary CDL Permit Docs Needed Failed Written Update CDL Medical Card Failed Driving Transcripts

Form Reviewed/Processed by LCTC Initials:

1 - IDENTIFICATION 2 - NAME CHANGE 3 - YOUR ADDRESS 4 - SOCIAL SECURITY

BRING ONE: • US Passport (expired is ok) • Original US Birth Certificate• Certified US Birth Certificate • Naturalization Certificate • INS (USCIS) Documentation

Does the name match your license or ID card? If not, don’t forget your name change documents; see box #2 on right

BRING ONE: • Social Security Card or Stub • W-2/1099 Form (pre-printed) • Pay Stub • Proof must list full name and full Social Security #.

Name changes must be reported to Social Security at least 24 hours prior to visiting our office. socialsecurity.gov 800.772.1213

BRING ALL THAT APPLY: • Original Marriage Certificate • Certified Marriage Certificate• Divorce Decree • Court Order

This is only required when a prior name (or maiden name) is shown on the identification document provided; see box #1 on left

BRING TWO from Residence: • Car or Boat Registration • Utility Bill or Credit Card Bill • Bank Statement • Voter Registration Card • Lease/Rental Agreement • Deed, Mortgage • Insurance Policy/Card

You can fill out a self-certification form in place of a second piece of mail. Must show name and address (not a post office box).

1. Yes No Have you ever been licensed in any US state(s) other than your current driver license in your lifetime?

If yes, list the most recent state(s): ____________________________________

2. Yes No Have you ever been adjudged by a court of law to be mentally incapacitated, suffering from any mental disorder or disease?

3. Yes No Do you have any physical or mental disabilities that could affect your driving? Any epilepsy, fainting, or dizzy spells within the last 2 years?

4. Yes No Are you addicted to drugs or intoxicants?

5. Yes No You can save the lives of EIGHT people and improve the lives of many more by being an organ donor. Say “YES” today to become/remain an organ donor!

6. Yes No Are you insulin dependent? If yes, would you like “Insulin Dependent” indicated on your license?

TRANSACTION DATE

Q-FLOW CASE ID # (Not Ticket #)

MONTH DAY YEAR

PG 2 of 2LCTC Rev. 04/20

OATH AND ACKNOWLEDGMENT (Required per s. 322.08, F.S.)

Under penalty of perjury, I (the applicant) swear or affirm that the information given by me in this application is true and correct. I understand that a person who knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of their official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes.

Signature of Applicant: Date:

This information must match your identification documents presented and will be used to create your Florida Driver License or ID Card.

FULL FIRST NAME ETHNICITY (Required as part of applicant’s description per s. 322.08, F.S.)

FULL MIDDLE NAME

FULL LAST NAME

SUFFIXJr., Sr., III

CURRENT DRIVER LICENSE NUMBER OR ID CARD (AREA CODE) PHONE NUMBER

COUNTRY OF BIRTH STATE OF BIRTH

STATE

HEIGHTFeet Inches

DATE OF BIRTHMonth Day Year

ADDRESS WHERE YOU LIVE (If different than above)

ADDRESS WHERE YOU RECEIVE MAIL

Street Address (No PO Box)

Street Address or PO Box

CITY

CITY

STATE

STATE

ZIP

ZIP

Asian Black Hispanic Native American White Other

SEXMale Female

VOTER’S REGISTRATION APPLICATION (s. 97.057, F.S.). Providing this information is voluntary. You must be a U.S. Citizen; be a Florida resident; be at least 18 years old; however, a customer who is at least 16 years old can pre-register to vote.

I decline (do not want) or I am ineligible to apply for a Florida voter’s registration card.

1. Select ONE of the following options: Note: Each driver license or ID card application serves as an application for voter registration unless otherwise indicated: By completing the information below, you agree to use your residential address (above) and signature (below)for voter registration purposes.

Current I am currently registered to vote in Florida and I don’t need to make any changes (skip to ‘Oath and Acknowledgment’). Change I need to change the following info on my Florida voter’s registration card: Address Party Name New I would like to apply for a first-time Florida voter’s registration card. If currently registered to vote in another state, provide your

out-of-state Address: City:

State: Zip:

2. Yes No By answering ‘Yes’, you are affirming you have NOT been adjudicated mentally incapacitated with respect to voting OR, if you have, your right to vote has been restored. Required per s. 97.041, F.S.

3. Yes No By answering ‘Yes’, you are affirming you are NOT a convicted felon, OR, if you are, your right to vote has been restored. Required per s. 97.041, F.S. NOTE: Your voting rights must be restored in order to be eligible to apply for a Florida voter’s registration.

4. Yes No Do you require voting assistance?

5. Yes No Are you interested in being a poll worker? A poll worker prepares the precinct by setting up voting equipment and providing voters with appropriate ballots. Refer to LakeVotes.com or call 352.343.9734 for details.

6. Party Affiliation check one box only Democrat Republican No Party Affiliation Minor party (party name):

7. Yes No Are you Active Duty Military or Merchant Marine?

8. Yes No Are you the dependent of Active Duty Military or Merchant Marine?

9. Yes No Are you a US Citizen currently residing outside of the US?

10. Yes No I understand that I can provide my email address and receive sample ballots and other voting information from the Supervisor of Elections office by visiting LakeVotes.com, calling 352.343.9734 for details.

Email address:

11. INITIAL HERE I do solemnly swear (or affirm) that I will protect and defend the Constitution of the United States and the Constitution of the State of Florida, that I am qualified to register as an elector under the Constitution and laws of the State of Florida, and that all information provided in this application is true.

return andpayment methods

DROPBOX:

MAIL:

PAYMENT:

EMAIL:

1800 David Walker Dr., Tavares, FL 32778

1720 North Citrus Blvd., Leesburg, FL 34748

scan for mobile-friendly list of locations on our website at laketax.com

1505 Hooks St., Clermont, FL 34711

Red dropboxes are located at the front of our offices.

Our office will contact you for payment when your transaction has been processed.

You may submit your documents via email to contactus@laketax.com

David W. Jordan Lake County Tax Collector P.O. Box 268 Tavares, FL 32778 352-343-9602 laketax.com

You may mail in this form to: David W. Jordan, Lake County Tax Collector P.O. Box 268, Tavares, FL 32778