Florida HSMV Form 84901 Complaint Affidavit Guide – The Florida HSMV Form 84901, officially titled the Complaint Affidavit, is the primary document used by consumers to file formal complaints with the Florida Department of Highway Safety and Motor Vehicles (FLHSMV) against licensed motor vehicle dealers, mobile home dealers, manufacturers, recreational vehicle (RV) dealers or manufacturers, and cases involving odometer fraud.
Issued by the Division of Motorist Services, Bureau of Dealer Services, this form allows Florida residents and vehicle buyers to report issues such as deceptive sales practices, failure to deliver titles, warranty problems, and other violations of Florida motor vehicle laws. The current revision is HSMV 84901 (Rev. 10/21).
Official Download Link: Download Florida HSMV Form 84901 Complaint Affidavit (PDF)
What Is Florida HSMV Form 84901?
Form 84901 is the official Complaint Affidavit used by the Florida Department of Highway Safety and Motor Vehicles. It serves as a sworn statement in which the complainant describes the nature of their complaint in chronological order and states the resolution they seek.
According to the official FLHSMV consumer complaints page, this form is required for filing complaints against licensed Florida dealers. It is listed on the department’s official forms page as “84901: Complaint Affidavit.”
The form covers the following categories:
- Motor Vehicle Dealer
- Mobile Home Dealer
- Mobile Home Manufacturer
- RV Dealer or Manufacturer
- Odometer Fraud
- Other (for related issues)
When Should You Use HSMV Form 84901?
You should complete and submit Form 84901 if you experience problems such as:
- A dealer fails to provide the vehicle title or registration after purchase
- A dealership closes without delivering the title or releasing a lien
- Suspected odometer fraud or mileage discrepancies
- Issues with mobile home or RV manufacturers or dealers
- Misrepresentation of vehicle condition, warranty, or financing terms by a licensed dealer
- Other violations related to licensed motor vehicle, mobile home, or RV businesses in Florida
Note that certain issues fall under other agencies. For example, Lemon Law claims and unfair trade practices are handled by the Florida Attorney General’s Office, while financing or GAP insurance complaints may go to the Florida Office of Financial Regulation or Department of Financial Services.
How to Download and Complete Form 84901?
The official form is available as a free PDF from the Florida DHSMV website:
https://www.flhsmv.gov/pdf/forms/84901.pdf
The form is three pages and includes sections for:
- Type of Complaint – Select the appropriate category (Motor Vehicle Dealer, Odometer Fraud, etc.).
- Complainant Information – Your full name, date of birth, address, phone numbers, email, and driver’s license or passport number.
- Dealership Information – Name of the dealership, dealer license number (if known), address, salesperson name, and contact details.
- Vehicle or Mobile Home Information – Year, make, model, purchase and delivery dates, VIN, tag number, and (for mobile homes/RVs) manufacturer details, HUD label, and Florida seal number.
- Nature of the Complaint – A detailed, chronological description of events. Accuracy of dates is essential.
- Desired Resolution – Explain what actions you believe will satisfy the complaint.
- Signature and Date – Sign and date the affidavit.
You may complete the form electronically, save it, and attach supporting documents, or print it and fill it out by hand.
Supporting Documents to Include
The form strongly recommends enclosing copies of all related documentation. Helpful items include:
- Purchase agreement or sales contract
- Receipts and cancelled checks
- Proof of vehicle insurance and registration
- Inspection reports
- Warranty documents
- Repair invoices
- Any correspondence with the dealer
Submitting complete documentation helps the regional office process your complaint more efficiently.
How to Submit the Completed Form?
Submit the completed Form 84901 and all supporting documents to the Regional Office responsible for the county where the dealer is located. The form itself lists the current regional offices, addresses, phone numbers, fax numbers, and email addresses.
You may:
- Email the completed form and scanned supporting documents to the appropriate regional email address
- Mail printed copies to the regional office address
- In some cases, fax the materials
Do not send the form to a general statewide address. Always use the office that covers the dealer’s county. A current list of regional offices also appears on the FLHSMV locations page.
For additional guidance, visit the official Consumer Complaints & Resources page: FLHSMV Consumer Complaints.
What Happens After You File?
Once received, the Bureau of Dealer Services reviews the complaint. The department may investigate, contact the dealer, and work toward a resolution. In cases where a dealership has gone out of business, the FLHSMV can sometimes issue an Out-of-Business Affidavit to help the consumer obtain a title and may provide information about the dealer’s surety bond company.
Processing times vary depending on the complexity of the case and the volume of complaints. Keeping copies of everything you submit is recommended.
Additional Resources and Related Agencies
While Form 84901 is the correct channel for licensed dealer complaints, other issues may require different agencies:
- Florida Lemon Law / Unfair Trade Practices – Florida Attorney General’s Office (Lemon Law Hotline: 1-800-321-5366)
- Financing or GAP Insurance Complaints – Florida Office of Financial Regulation or Department of Financial Services
- Repair or Service Issues – Florida Department of Agriculture and Consumer Services (1-800-HELPFLA)
Official FLHSMV Forms page: https://www.flhsmv.gov/resources/forms/
Key Tips for a Successful Complaint
- Be factual, chronological, and specific with dates.
- Attach clear copies of all supporting evidence.
- Send the form to the correct regional office based on the dealer’s location.
- Keep a complete copy of your submission for your records.
- Use the most current version of the form from the official FLHSMV website.
Conclusion
The Florida HSMV Form 84901 Complaint Affidavit is the essential first step for consumers seeking help from the state when dealing with problems involving licensed motor vehicle, mobile home, or RV dealers, or suspected odometer fraud. By carefully completing the form, providing thorough documentation, and submitting it to the proper regional office, you give the Florida Department of Highway Safety and Motor Vehicles the information needed to investigate and address your concerns.