Surrender Your Plate

Surrender Your Plate
Owner Name*

First NameLast Name
Phone*
Please enter a valid phone number.
Email*
example@example.com
License Plate Number*
Last Assigned VIN*
Surrendered By:

First NameLast Name
DL Number for Individual Submitting this form*
Acknowledgement
I hereby certify, under penalty of perjury, that I am the registrant for the vehicle information provided above (including VIN, year, make, and other details), or that I am duly authorized by the registrant to submit this form on their behalf.

I understand that pursuant to Section 837.06, Florida Statutes, “Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.”
Clear
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Should be Empty:

Acknowledgement