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Get FL Form 83043 2019-2024

FL Form 83043 Rev. 12/18 S IMPORTANT INFORM ATION ABOUT YOUR CHOICE You may check personalized plate availability at the department s website located at https //services. STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OR LICENSE PLATE AGENT OFFICE www. flhsmv*gov/locations/ AP P L I C AT I O N F O R P E R S O N AL I Z E D L I C E N S E P L AT E INSTRUCTIONS ARE INDICATED ON REVERSE SIDE Date of Application PLEASE CONTACT YOUR LOCAL COUNTY TAX COLLECTOR S OFFICE LICENSE PLATE AGENT OR REFER TO THE REVERSE SIDE OF THIS FORM FOR FEE INFORMATION* OWNER / APPLICANT IDENTIFICATION Owner s / Lessee s Name Sex Street Address City Date of Birth State Zip Co-Owner s / Co-Lessee s Name FEID VEHICLE INFORMATION Current Decal Number Current License Plate Number Title Number Vehicle Identification Number Vehicle Make Year Vehicle Type Color Vehicle Weight CERTIFICATION This is to certify that I am/we are the registered owner/lessee or co-owner/co-lessee of the motor vehicle referenced above. I/we authorize my/our name address and renewal date to be provided to the organization sponsoring the specialty license plate selected* Under penalties of perjury I/we declare that I/we have read the foregoing document and that the facts stated in it are true. Signature s LICENSE PLATE SELECTION see reverse side for plate choices Enter the type of license plate requested see reverse side of this form for types of plates and fees Specify the intended meaning/explanation for your personalized license plate configuration choice nickname initials etc* Please Note Use no more than the number of characters authorized for the type of license plate you have requested including a space or hyphen see reverse side. For license plates with center graphic allow two spaces for the logo or characters will cover the graphic design* Centered Graphic 7 characters may also have an additional space or hyphen* A regular motorcycle may have a Florida graphic* LOGO Left Graphic Specialty Motorcycle 5 characters A BC D 1 1ST CHOICE 2ND CHOICE 3RD CHOICE 4TH CHOICE Carefully read all information on the front and back of this application before completing the application* Complete the application form and submit it to your local county tax collector s office or license plate agent with the following items a* PROOF OF FLORIDA INSURANCE Proof of personal injury protection PIP and property damage liability insurance PDL must be submitted in the form of a card policy binder certificate of insurance or affidavit. b. A copy of your current registration certificate or renewal notice. c* Remittance fees payable to your county tax collector/license plate agent. Please allow six to eight weeks for the manufacture and delivery of the license plate. The license plate will be delivered to your county tax collector s office or license plate agent. flhsmv*gov/MVCheckPersonalPlate/ Your local county tax collector s office or license plate agent may assist you in determining if a specific type of license plate is available as well as the choice for personalization and the total cost of the license plate you desire including trucks with a net weight of more than 5 000 pounds for-hire vehicles and trailers.

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