State of Florida Department of Highway Safety and Motor Vehicles (FLHSMV) Form HSMV 82993, Separate Odometer Disclosure Statement and Acknowledgment Completed Form Examples and Samples
Find clear, filled-out examples and samples of the State of Florida Department of Highway Safety and Motor Vehicles (FLHSMV) Form HSMV 82993, the Separate Odometer Disclosure Statement and Acknowledgment. Learn how to correctly complete this required document for vehicle title transfers in Florida.
Florida HSMV Form 82993 Example – Private Vehicle Sale
How this form was filled:
This example shows Form HSMV 82993 completed for a private vehicle sale. It includes the seller's and buyer's information, complete vehicle details, the exact odometer reading, and the certification that the mileage is 'Actual'. Both parties have signed and dated the form as required.
Information used to fill out the document:
- Vehicle Year: 2018
- Vehicle Make: Honda
- Vehicle Body Style: Sedan
- Vehicle Model: Civic
- Vehicle Identification Number (VIN): 1HGFK5G51JEA04321
- Odometer Reading: 75123
- Odometer Certification: Actual Mileage (No Tenths)
- Transferor's (Seller's) Printed Name: Jane A. Smith
- Transferor's (Seller's) Address: 123 Palm Tree Lane, Miami, FL 33101
- Transferor's (Seller's) Signature: Jane A. Smith
- Transferee's (Buyer's) Printed Name: Michael T. Johnson
- Transferee's (Buyer's) Address: 456 Sunshine Avenue, Orlando, FL 32801
- Transferee's (Buyer's) Signature: Michael T. Johnson
- Date of Statement: 03/15/2026
What this filled form sample shows:
- Complete and accurate Vehicle Identification section, including Year, Make, Model, Body Style, and VIN.
- Correctly recorded Odometer Reading with no tenths of a mile.
- Properly checked Odometer Certification box for 'Actual Mileage'.
- Full details for both the Transferor (Seller) and Transferee (Buyer), including printed names, signatures, and full addresses.
- Clearly written Date of Statement in MM/DD/YYYY format.
Form specifications and details:
| Form Name: | HSMV 82993, Separate Odometer Disclosure Statement and Acknowledgment |
| Issuing Authority: | State of Florida Department of Highway Safety and Motor Vehicles (FLHSMV) |
| Use Case: | Private sale of a used motor vehicle where the title does not have a designated space for the odometer disclosure. |
| Jurisdiction: | State of Florida, USA |
Created: February 03, 2026 07:28 PM
