STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTOR VEHICLES Neil Kirkman Building - Tallahassee, FL 32399 APPLICATION FOR RETIREMENT OF A MOBILE HOME CERTIFICATE OF TITLE This is to certify that I/we, _____________________________________, am (Printed name of owner(s) the lawful owner of a _______________________________ mobile home. (Year) (Make) Florida Title Number ______________________________________________ Vehicle Identification Number ______________________________________ I/we further state that I/we wish to retire the certificate of title for the above described mobile home and the following documents have been recorded in the official records of the clerk of court in the county in which the real property is located, pursuant to s. 319.261, Florida Statutes, (photocopies of the recorded documents must be attached): · · The Florida Certificate of Title(s). A lien satisfaction for the lien on the face of the title(s) (if applicable), or a statement from the lienholder that such security interest will be released upon retirement of the certificate of title (if applicable). The legal description of the real property and if the property is leased, a copy of the lease agreement. A sworn statement by the owner of the real property stating that he/she is the owner of the mobile home and the home is permanently affixed to the real property in accordance with state law. · · Under Penalties of Perjury, I Declare That I Have Read The Foregoing Document and That The Facts Stated In It Are True. _________________________________________ ____________________________ (Signature of Owner(s) (Date) HSMV 82109 (Rev. 07/03) S BAR FORM NO. R-8.6 This Form is NOT copyrighted to the Florida Bar. It was adopted in 2006