12 If Applying for a Duplicate Certificate of Des 2021-2026

12. If applying for a duplicate Certificate of Destruction check here. 13. If this transfer of title is exempt from Florida sales tax due to a settlement of an insurance claim check here HSMV 82363 - REV. FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES APPLICATION FOR SALVAGE TITLE/CERTIFICATE OF DESTRUCTION SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE www. flhsmv*gov/offices/ Instructions on Reverse Side Check this box if you are requesting the certificate of title to be printed* TOTAL LOSS BY INSURANCE COMPANY TOTAL SALVAGE LOSS Insurance Company s Name UNINSURED/SELF-INSURED TOTAL THEFT LOSS Address City State Zip Date Declared Total Loss and Compensation Paid Policy Number Claim Number Date of Loss Sex Date of Birth FEID Number Driver License or Identification Card Number Company s E-Mail Address FEID DHSMV Account Owner s E-Mail Address VEHICLE DESCRIPTION Vehicle Identification Number Previous State of Issue SALVAGE BY OWNER S No Insurance Company Involved Owner s Name License Plate Number Year Weight Make Body Length Color BHP/CC Florida Title Number GVW/LOC Florida Current Date of Issue IMPORTANT SEE VEHICLE IDENTIFICATION NUMBER VERIFICATION ON REVERSE SIDE OF THIS FORM SALVAGE TITLE/CERTIFICATE OF DESTRUCTION NOTATION INFORMATION Sections 5 and 6 are not required to be completed for total theft loss or insurance declared total loss vehicles. 5. COMPLETE THIS SECTION FOR INSURANCE OR OWNER/SELF-INSURED MOBILE HOME 80 OF CURRENT RETAIL COST a* Enter the current retail cost of the mobile home. a Use any official used mobile home guide to establish current value b. Multiply line a by. 80 enter amount on this line. b c* Enter estimate of cost to repair physical and mechanical damage on this line c d. If amount on line c is equal to or more than amount on line b check here. Certificate of Destruction unrebuildable e. Insurance company ONLY If amount on line c is less than amount on line b check the applicable box Rebuildable f* Owner/self-insured ONLY If requesting a rebuildable when less than 80 check the applicable box For late model vehicle 7 years or newer with a retail cost of at least 7 500 before sustaining damage Enter motor vehicle s current retail cost on this line. a on this line. c 1. Insurance/owner/self-insured If amount on line c is equal to or more than amount on line b check here less than 80 would remain a clear title of the cost to repair or requesting rebuildable check the applicable box 7. If the motor vehicle is worth less than 7 500 or is not a late model vehicle more than 7 model years old AND a* HAS BEEN damaged wrecked or burned resulting in the residual value only being for parts or scrap metal check here b. HAS NOT been damaged wrecked or burned resulting in the residual value only being for parts or scrap metal check one 7 b applies to Insurance ONLY not owner/self-insured If the vehicle came to Florida with a title/ownership document indicating it is not repairable junked or for parts only regardless of age or value check here.