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Certification of Address

This document is a certification of address form from the Florida Department of Highway Safety and Motor Vehicles. The form requires a person to certify their name, date of birth, residential address, and signature. For homeless or incarcerated individuals, additional documentation like a shelter letter or address verification from the Department of Corrections is needed along with the completed form. Acceptable proof of residential address is also required.

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Madison Snyder
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547 views

Certification of Address

This document is a certification of address form from the Florida Department of Highway Safety and Motor Vehicles. The form requires a person to certify their name, date of birth, residential address, and signature. For homeless or incarcerated individuals, additional documentation like a shelter letter or address verification from the Department of Corrections is needed along with the completed form. Acceptable proof of residential address is also required.

Uploaded by

Madison Snyder
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES 2900 Apalachee Parkway Neil Kirkman Building

- Tallahassee, FL 32399

CERTIFICATION OF ADDRESS
Date I do hereby certify that:

Name

(First)

(Middle)

(Last)

Date of Birth

Resides at:

Street, Apartment

City

State

Zip Code

SPECIAL CONDITIONS: Self Certification Homeless* Released from Incarceration** Other

Signature of Addressee/Customer INSTRUCTIONS:

Print Name of Addressee/Customer

Date

A Certification of Address form completed and signed by the customer is accepted as proof of residential address, providing it is accompanied by: o One proof of residential address in the customers name or; o One proof of residential address in the name of the person with whom the customer resides. *** * Homeless customers may present a letter listing the customers name from a shelter, public assistance agency representative along with the completed Certification of Address form. ** Customers released from incarceration may present an Address Verification Letter from the Department of Corrections (with an Inmate Identification Card and Certificate of Discharge) along with the completed Certification of Address form. *** A list of documents that can be used as proof of residential address can be found at www.GatherGoGet.com. HSMV 71120 (Rev 04/13)

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