1. Current License Number:
Licensee Name:
Sole Proprietor Corporation Partnership
Limited Liability Limited Partnership (LLLP) Limited Liability Company/Partnership (LLC/LLP)
Fictitious (DBA) Name(s):
Physical Address:
Mailing Address:
Business Telephone Number: ( ) Cell Number: ( )
Business Email Address: Fax Number: ( )
2. Federal Employer Identification Number (FEID):
Proof of Identification/DL #, if Sole Proprietor or Partnership:
Type of Vehicle: Automobiles Motorcycles > 50 cc’s Motorcycles < 50 cc’s LSV
Line makes of vehicles and/or units manufactured, distributed, or imported:
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES
Please mail the completed renewal application and required documents to:
The Dealer License Section, 2900 Apalachee Parkway, Room A312 – MS 65,
Tallahassee, Florida 32399
RENEWAL APPLICATION
MOTOR VEHICLE MANUFACTURER, IMPORTER, OR DISTRIBUTOR
ANNUAL RENEWAL BIENNIAL (TWO YEARS) RENEWAL
HSMV 86219 (Rev. 6/13)
Please mail the completed renewal application and required documents to: The Dealer
License Section, 2900 Apalachee Parkway, Room A312 – MS 65, Tallahassee, Florida 32399.
PLEASE NOTE: LICENSES MUST BE RENEWED BY SEPTEMBER 30.
IF THERE ARE NO CHANGES FROM LAST YEAR, YOU MAY FILE THIS FORM TO RENEW YOUR LICENSE.
THIS FORM MAY ALSO BE USED FOR THE FOLLOWING:
C
hange of Mailing Address (Please Check Box If Mailing Address Needs Updating)
NOTE: If there is a change in the corporate officer status, please complete Form 84256, Application for a
License as a Motor Vehicle or Recreational Vehicle Manufacturer, Importer, or Distributor or A Mobile
Please see instruction guide for acceptable proof of acceptable identification
Street Address
City State Zip Code
(Enter Mailing Address Even if Same as Physical Address (Street or Post Office Box)
City State Zip Code
LICENSE NUMBER
ISSUE DATE
AMOUNT
CHECK NUMBER
CRS PAYMENT
NUMBER
DATE RECEIVED IN
DEALER LICENSE
SECTION
DATE
APPLICATION WAS
COMPLETED
FRVIS CUSTOMER
NUMBER
Division of
Corporations
Active
Inactive
OFFICE USE ONLY
Entered By: _______
Approved By: ______
Officer’s Signature (Required) Printed Name Title Date
RENEWAL APPLICATION FOR A LICENSE AS A MOTOR VEHICLE MANUFACTURER, IMPORTER, OR DISTRIBUTOR
HSMV 86219 (Rev. 6/13)
Please mail the completed renewal application and required documents to: The Dealer
License Section, 2900 Apalachee Parkway, Room A312 – MS 65, Tallahassee, Florida 32399.
ACCEPTABLE PROOF OF IDENTIFICATION INCLUDES:
♦ A Florida driver license or identification card (please include driver license/identification number in
appropriate space on form);
♦ An out of state driver license or identification card;
♦ A US passport;
♦ A Canadian driver license, identification card, or passport;
♦ A driver license or identification card from any US Territory (American Samoa, Guam, Marianas, Puerto
Rico, and the US Virgin Island; and
♦ An out of country passport.
A copy of the proof of identification must be submitted with your renewal form to the Department, unless the
proof of identification submitted is a Florida driver license or identification card (please include driver
license/identification number in appropriate space on form).
REQUIRED DOCUMENTS TO BE SUBMITTED WITH APPLICATION:
♦ A completed and signed renewal application form.
♦ License renewal fee of $100; please make check payable to DHSMV.
♦ License renewal fee of $200, if you are opting for a biennial (two years) renewal.
♦ A current financial statement or condensed balance sheet.
♦ A completed questionnaire on efforts to add new minority dealer points (form enclosed).
♦ Copy of certification from the Division of Corporations showing current registration of business and
fictitious name(s) (on-line access at www.sunbiz.org).
Under penalty of perjury, I do swear and affirm that the information contained in this application is true
and correct. I further certify that I am authorized to bind the application with my signature.
State of Florida
DEPARTMENT OF
HIGHWAY SAFETY AND MOTOR VEHICLES
TALLAHASSEE, FLORIDA 32399-0500
ANNUAL REPORT ON ADDITION OF MINORITY DEALER POINTS
Name of Business
Business Address
City, State, and Zip Code
Current Dealer License Number
This report is submitted to fulfill the requirements of section 320.63(3), Florida Statutes
(attach additional pages, if needed). See section 288.703, Florida Statutes, for definition of
“Minority.” Please check the appropriate boxes below:
1). We have made effort to add new Yes No N/A
minority dealer points.
2). We have encountered difficulties in our Yes No N/A
efforts to recruit minority dealers.
3). We have been successful in our efforts to Yes No N/A
recruit minority dealers during the past year.
Printed Name of the Officer Officer's Signature
Title
HSMV 84020 (Rev. 04/10)
DIVISIONS/FLORIDA HIGHWAY PATROL • DRIVER LICENSES • MOTOR VEHICLES • ADMINISTRATIVE SERVICES
2900 Apalachee Parkway, Neil Kirkman Building, Tallahassee, Florida 32399-0500
http://www.flhsmv.gov
