SECTION A – VEHICLE INFORMATION SECTION B - Florida Department of ...
STATE OF FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
DIVISION OF MOTORIST SERVICES SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE
offices
APPLICATION FOR HIGH OCCUPANCY VEHICLE (HOV) DECAL
Submit this completed application along with appropriate fees to your local license plate agency for processing.
SECTION A ? VEHICLE INFORMATION
Vehicle Identification Number
License Plate Number
Year
Make
Model
SECTION B - REGISTERED OWNER(S) OF RECORD (Individual or Business)
Registered Owner's Full Name (First, Middle, Last)
Owner's E-mail address
Driver License, ID Card, or FEID #
Registered Co-Owner's Full Name (First, Middle, Last) Lessee's Full Name (First, Middle, Last)
Co-Lessee's Full Name (First, Middle, Last) Residence or Business Address
Mailing Address (if different from above)
Co-Owner's E-mail Address Lessee's E-mail Address
Co-Lessee's E-mail Address City City
Driver License, ID Card, or FEID #
Driver License, ID Card, or FEID #
Driver License, ID Card, or FEID #
State
Zip
State
Zip
SECTION C - REQUIREMENTS The above described vehicle meets Federal Inherently Low Emission Vehicle (ILEV) federal regulations or is classified as a Hybrid vehicle and qualifies for a Florida HOV Decal which permits access to HOV lanes. The fees are $5.00 for an annual decal, $10.00 for a biennial decal, and a $.85 mail fee for either decal, if applicable. The decal expires on your date of birth and must be renewed annually or biennially.
SECTION D ? SIGNATURE(S)
I (We) hereby request a Florida HOV Decal for the above described vehicle:
Signature of Registered Owner
Date
Signature of Registered Co-Owner
Date
Signature of Lessee
Date
Signature of Co-Lessee
Date
Check your local phone book government pages or visit the following website for current mailing addresses:
HSMV 83027 S (Rev. 02/22)
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