How to Fill Out and Submit Florida HSMV 84901: Dealer Complaint Affidavit

Florida’s HSMV 84901 dealer complaint affidavit is the form you use to report a licensed motor vehicle, mobile home, or RV dealer — or a mobile home or RV manufacturer — to the Florida Department of Highway Safety and Motor Vehicles. Download it from the DHSMV website, complete the five sections, attach copies of your paperwork, and send the packet by email or mail to the regional office that covers the county where the dealership sits.1Florida Department of Highway Safety and Motor Vehicles. Consumer Complaints and Resources The form is free and does not need to be notarized.

What the Form Covers

At the top of the form you check one complaint type: motor vehicle dealer, mobile home dealer, mobile home manufacturer, RV dealer or manufacturer, odometer fraud, or “other” for a DHSMV-regulated transaction that doesn’t fit the earlier boxes.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

One boundary matters before you start. The form is for businesses licensed by the DHSMV. If you bought from a private individual, this isn’t your channel; a dispute like that goes through civil court or the Florida Attorney General’s consumer protection division. If you suspect odometer tampering, you can file the 84901 and also submit HSMV 80122 to the department’s Motor Vehicle Fraud Unit so the report reaches those investigators too.3Florida Department of Highway Safety and Motor Vehicles. Odometer Fraud Warning

How to Fill Out HSMV 84901

You can type into the PDF and save it, or print it and complete it by hand. Either way, you sign at the end.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

Complainant Information

Enter your full legal name, date of birth, home address with city, county, state, and zip, and at least one phone number. Fill in your email too so the regional office can reach you quickly. For identification, the form accepts any one of the following: a Florida driver license or ID number, an out-of-state or U.S. territory driver license number, or a U.S. or foreign passport number.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

Dealership Information

Provide the dealership’s name, address, county, and the salesperson you dealt with. If you know the dealer’s license number, add it — it’s often printed on your purchase agreement or bill of sale, and it lets DHSMV pull the file at once. If you don’t have it, leave the field blank; the regional office can look it up.

Vehicle or Mobile Home Information

Fill in the year, make, and model, the VIN, the tag number if the vehicle is registered, the purchase date, and the delivery date. Purchase and delivery dates carry real weight because some violations depend on timing, such as whether the dealer transferred the title within the required window.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

Mobile Home, RV, or Park Trailer Section

Skip this section unless the complaint involves a mobile home, RV, or park trailer. If it does, enter the manufacturer’s name and address, the Florida Seal Number, and the HUD Label number. The HUD Label is a red or silver metal tag usually mounted on the rear of the unit. On RVs and park trailers, the Florida Seal Number is typically near the HUD label or on the front of the unit.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

The Narrative and Desired Resolution

This is the section that decides whether your complaint moves. You get two open fields: one for what happened, one for what you want.

Write the narrative as a timeline. “On [date], I visited the dealership. On [date], I signed the purchase agreement. On [date], I noticed [problem].” Stick to facts an investigator can verify: dates, dollar amounts, what was said, and who said it. Skip how the experience made you feel. If a salesperson made a specific promise about the vehicle’s history, condition, or warranty, quote it and put a date on it.

Then be concrete about the fix you want. “Refund of my $2,500 deposit” gives the investigator a target. “Justice” does not.

Sign and date the bottom of the form.

Documents to Attach

Enclose copies of anything that supports your account. The form specifically lists these:2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

  • Purchase agreement, buyer’s order, finance agreement, or lease contract
  • Receipts and cancelled checks for any payments to the dealer
  • Proof of vehicle insurance (declarations page)
  • Any registration paperwork the dealer provided or should have
  • Independent inspection reports
  • Written warranty documents given at the sale
  • Repair invoices tied to the problem you’re reporting

Send copies, never originals. If you’re filing electronically, scan the form and documents into one file. If you’re mailing, photocopy everything first.

Written communication with the dealer is worth adding even though the form doesn’t list it: text messages, emails, and dated notes from phone calls. Verbal promises are hard to prove, but a text from a salesperson stating that a car has never been in an accident can be strong evidence of misrepresentation.

Where to Send It

File with the DHSMV regional office for the county where the dealership is located, not where you live. You can email the completed form and scanned documents, or print and mail the packet.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

  • Region 1 (Broward): 1135 Banks Road, Margate, FL 33063 — DmvRegion1@flhsmv.gov
  • Region 2 (Alachua, Gilchrist, Lake, Levy, Marion, Putnam): 318 SE 25th Avenue, Ocala, FL 34471 — DmvRegion2@flhsmv.gov
  • Region 3 (Baker, Bradford, Clay, Columbia, Duval, Flagler, Nassau, St. Johns, Union): 9550 Regency Square Blvd., Suite 100, Jacksonville, FL 32225 — DmvRegion3@flhsmv.gov
  • Region 4 (Brevard, Seminole, Volusia): 1697 N. Woodland Blvd., Suite 111D, DeLand, FL 32720 — DmvRegion4@flhsmv.gov
  • Region 5 (Orange, Osceola): 4101 Clarcona-Ocoee Road, Suite 160, Orlando, FL 32810 — DmvRegion5@flhsmv.gov
  • Region 6 (Citrus, Hernando, Hillsborough, Pasco, Pinellas, Polk, Sumter): 5701 E. Hillsborough Avenue, Suite 2228, Tampa, FL 33610 — DmvRegion6@flhsmv.gov
  • Region 7 (Bay, Calhoun, Dixie, Escambia, Franklin, Gadsden, Gulf, Hamilton, Holmes, Jackson, Jefferson, Lafayette, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Suwannee, Taylor, Wakulla, Walton, Washington): 2900 Apalachee Parkway, Room B-139, MS-76, Tallahassee, FL 32399-0600 — DmvRegion7@flhsmv.gov
  • Region 8 (Charlotte, Collier, DeSoto, Glades, Hardee, Hendry, Highlands, Lee, Manatee, Sarasota): 1201 9th Avenue West, Bradenton, FL 34205 — DmvRegion8@flhsmv.gov
  • Region 9 (Indian River, Martin, Okeechobee, Palm Beach, St. Lucie): 901 Northpoint Parkway, Suites 115–116, West Palm Beach, FL 33407 — DmvRegion9@flhsmv.gov
  • Region 10 (Miami-Dade, Monroe): 12601 NW 42nd Avenue, Opa-Locka, FL 33054 — DmvRegion10@flhsmv.gov

If you’re unsure which region a county falls under, the DHSMV website has a regional office locator.1Florida Department of Highway Safety and Motor Vehicles. Consumer Complaints and Resources

What Happens After You File

The regional office contacts the dealer and gives them a window to respond, typically 10 to 15 business days. An investigator then reviews your complaint, the dealer’s response, and the documents both sides submitted. The department may close the file with no action, require the dealer to correct the problem, impose administrative penalties, or refer the case for further enforcement.

For motor vehicle dealers, DHSMV can suspend or revoke the dealer’s license for fraud, willful misrepresentation, failure to transfer a title, or a pattern of misleading sales practices, and violations under that statute are classified as a second-degree misdemeanor.4The Florida Legislature. Florida Statutes 320.27 – Motor Vehicle Licenses For mobile home dealers, the department can impose administrative fines up to $1,000 per violation in addition to license action.5The Florida Legislature. Florida Statutes 320.77 – Mobile Home Dealers

If the dealership has closed before your complaint is resolved, DHSMV can issue an Out-of-Business Affidavit that may help you obtain a title, and the department will send a letter explaining your options and identifying the dealer’s surety bond company, which may cover your financial loss.1Florida Department of Highway Safety and Motor Vehicles. Consumer Complaints and Resources

Making Your Complaint Stronger

Investigators read a lot of these, and the ones that get traction share a few habits. Lead with the specific violation, not the backstory. “The dealer sold me a vehicle without disclosing prior structural damage” tells an investigator immediately which statute applies. Pin down every date you can: the lot visit, the contract signing, the delivery, the day you found the problem, and the day you first raised it with the dealer. The form asks you to list events in order and to confirm the dates are accurate.2Florida Department of Highway Safety and Motor Vehicles. HSMV 84901 – Complaint Affidavit

Keep the resolution you’re asking for within what DHSMV can actually do. The department can push a dealer to meet its legal obligations and can impose administrative penalties. It cannot order the dealer to pay you damages the way a court can. If your losses are significant, a claim against the dealer’s surety bond or a civil case can run alongside the DHSMV complaint.