HomeMy WebLinkAboutInv# PC - 22542 - BROWARD COUNTY TAX COLLECTOR - 11/07/2024Broward County Records, Taxes & Treasury Div.
Broward County Tax Collector 115 S. Andrews Ave. Room A100 Fort Lauderdale, FL 33301
raitsact1_6fi_ _5HgU+------___
Cashier:
DR
-----------------------
Paid By:
YAMILLOBO___
! Posted Date:
11/07/2024 09:31AM
Received Via: --
In Person
Num. Items:
6
Total Tendered
— $358.65
-------------------------_
Receipt M
006-24-00000494
--------------------------
Batch:
602973
Drawer:
_—
6
— — --
—---
Status:
Complete
Receipt
Item
Details
Effective
Due
Paid
Date
---
FRVIS _
Plantation ^11/07/2024
$39.30
$39.30
Batch# 2687139
VIN:
3FTTW8H95RR650955
Code:ORR
_______
FRVIS
—Code:�� _ --@—
__
11/07/2024
�$80.25—
$80.25
Batch# 2687139
VIN:
3FTTW8H95RR650955
C_o_de:_ORT
—
___ _
FRVIS —_Plantation
_ ___
_ 1/07/2024
___
_$39.30~
$39.30
Batch# 2687143
VIN:
3FTTW8H98RRB50965
Code: ORR
FRVIS
Plantation
11/07/2024
$80.25
$80.25
Batch# 2687143
VIN:
3FTTW8H98RRB50965
Code:ORT
_____
FRVIS
—Plantation_
11/07/2024
�$39.30
$39.30
Batch# 2687143
VIN:
3FTTW8H92RRB50833
C_o_de:_O_RR__
_____
FRVIS—�Plantation�
^� —
11/07/2024
a $80.25
-- $80.25
Batch# 2687143
VIN:
3FTTW8H92RRB50833
C_o_de: ORT
-------�Total:_________.�__.__.__
$358.65�—^--�$358.65
Payment
Details
Peic3 ------
Credit or
Visa CC#XXXX-6692
$358.65
Debit Card
Confirmation number:
H8317475301
AID: A0000000031010
TDS:emv
Application Label: VISA
CREDIT
PIN Statement: 1
Auth Code: 028058
Balance:
$0.00
s$9.15
Convenience
Fee:
Total
$367.80
Charged:
J.
Fernando
odrlguez
�hlic Serviced
CNTY# AGY# SUB# 654 d.. tE
- ,IIIoff'OL
VMRIIIIIII
IIIT## 4173371
10DSR 6542 -=`_ 2040621019
161 STATE OF FLORIDA B# 2687143
AUDIT# H�oUW¢ APPLICATION FOR VEHICLE/VESSEL S# 109374468
CERTIFICATE OF TITLE - -- - -- -
TITLE NUMBER VEHICLEIVESSEL IDENTIFICATION # YR. MAKE MAKE or BODY VEHICLE COLOR WT/LENGTH PRINCPL GVW/LOC
MANUFACTURER TYPE OPERAT
rr l ��
L156818878 J �FTTMHWRR�B5083� 2024 FORD LPK WI1I ( �3416 �— �— --�
, L
-
DATE OF ISSUE TRANS VEHICLE USE HULL PROPULSION ENGINE FUEL VESSEL —JWATER FL NUMBER AUTH
MO. DAY YEAR CODE MATERIAL DRIVE TYPE DESTRUCTION
[11O7 24 ORT PRIVATE
T-
BIRTHDATE RESIDENT CNTY
SEX MO. DAY YEAR Y N ALIEN REST
Applicant/Owner's Name &Address ( T
CITY OF DANIA BEACH 10
1201 STIRLING RDI—
DANIA BEACH, FL 33004 1st OWNER FUDL# OR 2nd OWNER FUDL# OR
F.ELD.# UNIT#
I
VOLUNTARY CONTRIBUTIONS
AGENCY TITLE FEE SALES TAX GRAND TOTAL
FEE
0.00--- 80_25
75.50 �—
-
Action Requested: ORIGNEWTITLE Brands:
PREV.STATE
DATE ACQUIRED
NEW
USED
ODOMETER VESSEL MANUFACTURER ODOMETER
DECLARATION
CERTIFICATION
10/31/2024
XX
50 MI 10/31/2024 ACTUAL ❑
LIED] INFORMATION DATE OF LIEN RECEIVED DATE FEID # OR FL / DL AND SEXAND DATE OF BIRTH DMV ACCOUNT #
NAME OF FIRST LIENHOLDER:
ADDRESS SALVAGE TYPE
SELLER INFORMATION
NAME OF SELLER, FLORIDA DEALER, OR OTHER PREVIOUS OWNER
ADDRESS
I
DEALER LICENSE NO.
- --
CONSUMER OR SALES TAX EXEMPTION #
SALES TAX AND USE REPORT INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY $
UNPAID BALANCE DUE SELLER, BANK OR OTHERS
TRANSFER OF TITLE PURCHASER HOLDS VALID ❑
IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ 0.00 ,
FLORIDA SALES OR ❑ VEHICLE / VESSEL WILL BE 212, FLORIDA STATUTES
USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL
REASON(S) CHECKED ® OTHER EXEMPT ❑ SELLING PRICE VERIFIED
'APPLICANT CERTIFICATION
IIWE HEREBY CERTIFY THAT THE VEHICLENESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYSMATERWAYS OF THIS STATE.
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
UWE HEREBY CERTIFY THAT VINE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPLICATION FOR TITLE. IF LIEN IS BEING RECORDED NOTICE IS HEREBY GIVEN THAT THERE IS AN
EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY LIENHOLDER SHOWN ABOVE. UWE FURTHER AGREE TO DEFEND THE TITLEAGAINSTALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature of Applicant/Owner Signature of Applicant/Co-Owner
HSMV 82041 REVISED 02106 SCAN CODE MVT
I UNDERSTAND THAT MY DRIVER LICENSE AND REGISTRATIONS WILL BE SUSPENDED IMMEDIATELY IF THE INSURER DENIES MTRFS021Y
THE INSURANCE INFORMATION SUBMITTED FOR THIS REGISTRATION.
MTRFS020
IMPORTANT INFORMATION
Section 316.613, Florida Statutes, requires every operator of a motor vehicle transporting
a child in a passenger car, van, autocycle or pickup truck registered in this state and
operated on the highways of this state, shall, if the child is 5 years of age or younger,
provide the protection of the child by properly using a crash -tested, federally approved child
restraint device. For children aged through 3 years, such restraint device must be a separate
carrier or a vehicle manufacturer's integrated child seat. For children aged 4 through 5 years,
a separate carrier, an integrated child seat, or a child booster seat may be used.
For limited exceptions, see s. 316.613, F.S.
S. 320.0605, F.S., requires the registration certificate, or true copy of a rental or lease
agreement, issued for any motor vehicle to be in the possession of the operator or carried in
the vehicle while the vehicle is being used or operated on roads of this state.
S. 320.02 and 627.733, F.S., requires personal injury protection and property damage
liability to be continuously maintained throughout the registration period. Failure to maintain
the mandatory coverage may result in the suspension of your driver license and registration.
Mail To:
CITY OF DANIA BEACH Important note: If you cancel the insurance for this vehicle,
1201 STIRLING RD immediately return the license plate from this registration to a Florida
DANIA BEACH, FL 33004 driver license or tax collector office or mail it to: DHSMV, Return Tags,
2900 Apalachee Parkway, Tallahassee, FL 32399. Surrendering the plate
will prevent your driving privilege from being suspended.
CO/AGY 10 / 6
FLORIDA VEHICLE REGISTRATION
?LATE XL8657 DECAL Expires NO EXPIRATION
(R/MK 2024/FORD BODY PK
11N 3FTTW8H92RRB50833
'late Type CVR NET WT 3416
)L/FEID -
)ate Issued 11/7/2024 Plate Issued 11/7/2024
:ITY OF DANIA BEACH
201 STIRLING RD
)ANIA BEACH, FL 33004
:VR - CITY VEHICLES PLATE ISSUED X
COLOR WHI Reg. Tax
TITLE 166818878 Init. Reg.
County Fee
Mail Fee
Sales Tax
Voluntary Fees
Grand Total
T#
2040621389
B#
2687143
36.30
Cass Code
Tax Months
3.00
Back Tax Mos
Credit Class
Credit Months
3 9.3 0
IMPORTANT INFORMATION
97
12
1. The Florida license plate must remain with the registrant upon sale of vehicle.
2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
a replacement vehicle,
3. Your registration must be updated to your new address within 30 days of moving.
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30-day period prior to the expiration date shown on this registration. Renewal
notices are provided as a courtesy and are not required for renewal purposes.
5. I understand that my driver license and registrations will be suspended
immediately if the insurer denies the insurance information submitted
for this registration.
CNTY# TAGY# SUB# RPT# �ttrBs 'IIIo40 �'I III T## 4173364
016 DSR 6542 ■ �' 2040617757
- �- - STATE OF FLORIDA B# 2687143
AUDIT# — a�oa APPLICATION FOR VEHICLE/VESSEL s# 109374191
CERTIFICATE OF TITLE
TITLE NUMBER VEHICLE/VESSEL IDENTIFICATION # YR. MAKE MAKE or BODY VEHICLE COLOR WT/LENGTH PRINCPL GVW/LOC
MANUFACTURER TYPE OPERAT
rr
156818809 [3FTTW8H98RRB50965 L2024 FORD
DATE OF ISSUE TRANS VEHICLE USE HULL PROPULSION ENGINE FUEL VESSEL WATER FL NUMBER AUTH
MO. DAY YEAR CODE MATERIAL DRIVE TYPE DESTRUCTION
]ORT PRIVATE T
1 07T-2
I111
BIRTHDATE RESIDENT CNTY
SEX MO. DAY YEAR Y N ALIEN RES.#
AppllcanUOwnel's Name &Address r -- -- r - - LI
CITY OF DANIA BEACH L� I X 1
IRLINGBEACH RDL—
#
DANIA BEACH, FL 33004 II 1st OWNER FUDL# OR 2nd OWNER FUDL# OR
A A
F.E.I.D.# UNIT#
l
VOLUNTARY CONTRIBUTIONS
AGENCY
TITLE FEE SALES TAX GRAND TOTAL
FEE
4.75 E75-51o
E0.00 L 80.25
Action Requested: ORIGNEWTITLE Brands:
PREV.STATE
DATEACOUIRED
NEW
USED
ODOMETER/VESSEL MANUFACTURER ODOMETER
DECLARATION
CERTIFICATION
10/31/2024
XX
36 MI 10/31/2024 ACTUAL ❑
LIEN INFORMATION DATE OF LIEN RECEIVED DATE FEID # OR FL/ OLAND SEXAND DATE OF BIRTH DMVACCOUNT#
NAME OF FIRST LIENHOLDER:
ADDRESS SALVAGE TYPE
SELLER INFORMATION
NAME OF SELLER, FLORIDA DEALER, OR OTHER PREVIOUS OWNER
ADDRESS
DEALER LICENSE NO.
— ---
-- --
CONSUMER OR SALES TAX EXEMPTION #
SALES TAX AND USE, REPORT INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY $
UNPAID BALANCE DUE SELLER, BANK OR OTHERS
TRANSFER OF TITLE ❑ PURCHASER HOLDS VALID ---------
IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ 0.00
FLORIDA SALES OR ❑ VEHICLE / VESSEL WILL BE 212, FLORIDA STATUTES
USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL
REASON(S) CHECKED ® OTHER EXEMPT ❑ SELLING PRICE VERIFIED
APPLICANT CERTIFICATION
IME HEREBY CERTIFY THAT THE VEHICLEIVESSEL TO BE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYSMATERWAYS OF THIS STATE.
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
I CERTIFY THAT THIS MOTOR VEHICLENESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
IAVE HEREBY CERTIFY THAT IAVE LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPLICATION FOR TITLE. IF LIEN IS BEING RECORDED NOTICE IS HEREBY GIVEN THAT THERE IS AN
EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY LIENHOLDER SHOWN ABOVE. VWE FURTHER AGREE TO DEFEND THE TITLEAGAINST ALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT i HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature ofAppl(canUOwner Signature o(ApplicanUCo-Owner
HSMV 82041 REVISED 02/06 SCAN CODE Iy VT
-- --
I UNDERSTAND THAT MY DRIVER LICENSE AND REGISTRATIONS WILL BE SUSPENDED IMMEDIATELY IF THE INSURER DENIES MTRFS021Y
THE INSURANCE INFORMATION SUBMITTED FOR THIS REGISTRATION.
N ffRFS020
IMPORTANT INFORMATION
Section 316.613, Florida Statutes, requires every operator of a motor vehicle transporting
a child in a passenger car, van, autocycle or pickup truck registered in this state and
operated on the highways of this state, shall, if the child is 5 years of age or younger,
provide the protection of the child by properly using a crash -tested, federally approved child
restraint device. For children aged through 3 years, such restraint device must be a separate
carrier or a vehicle manufacturer's integrated child seat. For children aged 4 through 5 years,
a separate carrier, an integrated child seat, or a child booster seat may be used.
For limited exceptions, see s. 316.613, F.S.
S. 320.0605, F.S., requires the registration certificate, or true copy of a rental or lease
agreement, issued for any motor vehicle to be in the possession of the operator or carried in
the vehicle while the vehicle is being used or operated on roads of this state.
S. 320.02 and 627.733, F.S., requires personal injury protection and property damage
liability to be continuously maintained throughout the registration period. Failure to maintain
the mandatory coverage may result in the suspension of your driver license and registration.
Mail To:
CITY OF DANIA BEACH Important note: If you cancel the insurance for this vehicle,
1201 STIRLING RD immediately return the license plate from this registration to a Florida
DANIA BEACH, FL 33004 driver license or tax collector office or mail it to: DHSMV, Return Tags,
2900 Apalachee Parkway, Tallahassee, FL 32399. Surrendering the plate
will prevent your driving privilege from being suspended.
CO/AGY 10 / 6
FLORIDA VEHICLE REGISTRATION
"LATE XL8656 DECAL Expires NO EXPIRATION
(R/MK 2024/FORD BODY PK
/IN 3FTTW8H98RRB50965
'late Type CVR NET WT 3416
)L/FEID -
)ate Issued 11/7/2024 Plate Issued 11 /7/2024
:ITY OF DANIA BEACH
201 STIRLING RD
)ANIA BEACH, FL 33004
;VR - CITY VEHICLES PLATE ISSUED X
COLOR WHI Reg. Tax
TITLE 156818809 Init. Reg.
County Fee
Mail Fee
Sales Tax
Voluntary Fees
Grand Total
T#
2040618417
B#
2687143
36.30
Class Code
Tax Months
3.00
Back Tax Mos
Credit Class
Credit Months
39.30
IMPORTANT INFORMATION
97
12
1. The Florida license plate must remain with the registrant upon sale of vehicle.
2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
a replacement vehicle.
3. Your registration must be updated to your new address within 30 days of moving.
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30-day period prior to the expiration date shown on this registration. Renewal
notices are provided as a courtesy and are not required for renewal purposes.
5. I understand that my driver license and registrations will be suspended
immediately if the insurer denies the insurance information submitted
for this registration.
CNTY# AGY# SUB# RPT# brie s
10 6 DSR 6542 D!r
ALIDIT#
1111 Wq.. njePtu&A Fill II
STATE OF FLORIDA
APPLICATION FOR VEHICLE/VESSEL
CERTIFICATE OF TITLE
L# 4173359
T# 2040613191
B# 2687139
S# 109373920
TITLE NUMBER VEHICLENESSEL IDENTIFICATION # YR. MAKE MAKE or BODY VEHICLE COLOR WT/LENGTH PRINCPL GVW/LOC
MANUFACTURER TYPE OPERAT
L56818721 3FTTW8H95RRB50955 2024 FORD PK F3416 I
DATE OF ISSUE TRANS VEHICLE USE HULL PROPULSION ENGINE FUEL VESSEL WATER FL NUMBER AUTH
MO. DAY YEAR CODE MATERIAL DRIVE TYPE DESTRUCTION
—
F[07J2� ORT PRIVATE A
:L
BIRTHDATE RESIDENT CNTY
SEX MO. DAY YEAR Y N ALIEN REST
Applicant/Owners Name &Address
CITY OF DANIA BEACH L47
LLEJ Lx Fl] I_1�
1201 STIRLING RD
DANIA BEACH, FL 33004 1st OWNER FUDL# OR 2nd OWNER FUDL# OR
F.E.1 . D . # LINIT#
VOLUNTARY CONTRIBUTIONS
AGENCY TITLE FEE SALES TAX GRAND TOTAL
FEE
4.75 [ =75.50 1--:--0.00 80,25
Action Requested: CIRIGNEWTITLE Brands:
PREY. STATE
DATE ACQUIRED
NEW
USED
ODOMETER /VESSEL MANUFACTURER ODOMETER
DECLARATION
CERTIFICATION
10/31/2024
Xx
40 MI 10/31/2024 ACTUAL E-1
LIEN INFORMATION DATE OF LIEN RECEIVED DATE FEID # OR FL 1 DLAND SEXAND DATE OF BIRTH DMVACCOUNT#
NAME OF FIRST LIENHOLDER;
ADDRESS SALVAGE TYPE
SELLER INFORMATION
NAME OF SELLER, FLORIDA DEALER, OR OTHER PREVIOUS OWNER
ADDRESS
DEALER LICENSE NO.
CONSUMER OR SALES TAX EXEMPTION #
SALES TAX AND USE REPORT INDICATE TOTAL PURCHASE PRICE, INCLUDING ANY $
UNPAID BALANCE DUE SELLER, BANK OR OTHERS
TRANSFER OF TITLE 0 PURCHASER HOLDS VALID
IS EXEMPT FROM EXEMPTION CERTIFICATE INDICATE SALES OR USE TAX DUE AS PROVIDED BY CHAPTER $ 0.00
FLORIDA SALES OR El VEHICLE / VESSEL WILL BE 212, FLORIDA STATUTES
USE TAX FOR THE USED EXCLUSIVELY FOR RENTAL
REASON(S) CHECKED M OTHER EXEMPT E SELLING PRICE VERIFIED
APPLICANT CERTIFICATION
ItWE HEREBY CERTIFY THAT THE VEHICLENESSEL TO HE TITLED WILL NOT BE OPERATED UPON THE PUBLIC HIGHWAYS/WATERWAYS OF THIS STATE.
I CERTIFY THAT THE CERTIFICATE OF TITLE IS LOST OR DESTROYED.
I CERTIFY THAT THIS MOTOR VEHICLE/VESSEL WAS REPOSSESSED UPON DEFAULT OF THE LIEN INSTRUMENT AND IS NOW IN MY POSSESSION.
if —WE HEREBY CERTIFY THAT )ME LAWFULLY OWN THE ABOVE DESCRIBED VEHICLENESSEL, AND MAKE APPLICATION FOR TITLE. IF LIEN IS BEING RECORDED NOTICE 15 HEREBY GIVEN THAT THERE IS AN
EXISTING WRITTEN LIEN INSTRUMENT INVOLVING THE VEHICLENESSEL DESCRIBED ABOVE AND HELD BY LIENHOLDER SHOWN ABOVE. I(WE FURTHER AGREE TO DEFEND THE TITLEAGAINST ALL CLAIMS.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING DOCUMENT AND THAT THE FACTS STATED IN IT ARE TRUE.
Signature ofApplicanVOwnbr Signature of Applicant/Co-Owner
HSMV 82041 REVISED 02/06 SCAN CODE MVT
I UNDERSTAND THAT MY DRIVER LICENSE AND REGISTRATIONS WILL BE SUSPENDED IMMEDIATELY IF THE INSURER DENIES MTRFS021 Y
THE INSURANCE INFORMATION SUBMITTED FOR THIS REGISTRATION.
MTRFS020
Mail To:
CITY OF DANIA BEACH
1201 STIRLING RD
DANIA BEACH, FL 33004
IMPORTANT INFORMATION
Section 316.613, Florida Statutes, requires every operator of a motor vehicle transporting
a child in a passenger car, van, autocycle or pickup truck registered in this state and
operated on the highways of this state, shall, if the child is 5 years of age or younger,
provide the protection of the child by properly using a crash -tested, federally approved child
restraint device. For children aged through 3 years, such restraint device must be a separate
carrier or a vehicle manufacturer's integrated child seat. For children aged 4 through 5 years,
a separate carrier, an integrated child seat, or a child booster seat may be used.
For limited exceptions, see s. 316.613, F.S.
S. 320,0605, F.S., requires the registration certificate, or true copy of a rental or lease
agreement, issued for any motor vehicle to be in the possession of the operator or carried in
the vehicle while the vehicle is being used or operated on roads of this state.
S. 320.02 and 627.733, F.S., requires personal injury protection and property damage
liability to be continuously maintained throughout the registration period. Failure to maintain
the mandatory coverage may result in the suspension of your driver license and registration.
Important note: If you cancel the insurance for this vehicle,
immediately return the license plate from this registration to a Florida
driver license or tax collector office or mail it to: DHSMV, Return Tags,
2900 Apalachee Parkway, Tallahassee, FL 32399. Surrendering the plate
will prevent your driving privilege from being suspended.
CO/AGY 10 / 6 T# 2040614453
REGISTRATION B 2687139
FLORIDA VEHICLE
'LATE XL8655 DECAL Expires NO EXPIRATION
(R/MK 2024/FORD BODY PIK
✓IN 3FTTW8H95RRB50955
'late Type CVR NET WT 3416
WFEID -
)ate Issued 11 /7/2024 Plate Issued 11/7/2024
:ITY OF DANIA BEACH
201 STIRLING RD
)ANIA BEACH, FL 33004
:VR - CITY VEHICLES PLATE ISSUED X
COLOR WHI Reg. Tax 36.30 Class Code 97
TITLE 166818721 Init. Reg. Tax Months 12
County Fee 3.00 Back Tax Mos
Mail Fee Credit Class
Sales Tax Credit Months
Voluntary Fees
Grand Total 39.30
IMPORTANT INFORMATION
1. The Florida license plate must remain with the registrant upon sale of vehicle.
2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to
a replacement vehicle.
3. Your registration must be updated to your new address within 30 days of moving.
4. Registration renewals are the responsibility of the registrant and shall occur during
the 30-day period prior to the expiration date shown on this registration. Renewal
notices are provided as a courtesy and are not required for renewal purposes.
5. I understand that my driver license and registrations will be suspended
immediately if the insurer denies the insurance information submitted
for this registration.