Florida Department of Highway Safety and Motor Vehicles · Florida state form
HSMV-84019 Application and Claim to Recover Compensation
Use HSMV-84019 to request compensation from the Mobile Home and Recreational Vehicle Trust Fund for an unsatisfied judgment or claim against a dealer, broker, or surety.
- What this form is
- This application collects claimant, unit, dealer or broker, and surety information for a request for compensation from the Mobile Home and Recreational Vehicle Trust Fund. Select the section for an unsatisfied judgment or bankruptcy, complete the sworn statement, and include the supporting documents listed for that claim type. The form states that incomplete claims cannot be processed until required documentation is submitted.
- Who needs it
- Claimants seeking trust fund compensation for an unsatisfied judgment or claim involving a mobile home or recreational vehicle dealer, broker, or surety may use this application.
- Why it needs a notary
- The claimant's statement must be sworn or affirmed before a notary. This can be done online with a commissioned online notary.
- How to submit it
- Complete the application and include the required supporting documents. Forward them to the Claims Administrator, Division of Motorist Services, 2900 Apalachee Parkway, MS-55, Tallahassee, Florida 32399.
Questions
What is HSMV-84019 used for?
It is an application to request compensation from the Mobile Home and Recreational Vehicle Trust Fund for an unsatisfied judgment or claim against a dealer, broker, or surety.
What documents must accompany the application?
Required documents depend on whether the claim is based on an unsatisfied judgment or bankruptcy. The form lists the supporting records for each claim type and says incomplete claims cannot be processed.
Does HSMV-84019 need to be notarized?
Yes. The claimant's statement must be sworn or affirmed and subscribed before a notary. This can be done online with a commissioned online notary.