Form HSMV 84901. Complaint Affidavit - Florida

Form HSMV 84901 is used in Florida as a complaint affidavit to report violations or offenses related to motor vehicles. This form allows individuals to formally document complaints and provide supporting information regarding incidents they have witnessed or experienced.

The form consists of sections and important fields, including:

• Complainant Information: This section requires the complainant's name, address, contact information, and any applicable identification numbers.
• Offense Details: Here, the complainant provides a description of the offense or violation, including the date, time, location, and any relevant details.
• Witness Information: If there were witnesses to the incident, their names, addresses, and contact information can be included in this section.
• Statement: The complainant provides a detailed statement explaining the incident, including the sequence of events and any supporting evidence or documents.
• Signature: The form must be signed by the complainant, affirming the accuracy of the information provided.

When filling out this form, it is important to provide accurate and detailed information about the offense or violation. Including any available evidence will strengthen the complaint. It is essential to be truthful and concise when providing the statement. This form is used to initiate an official complaint process within the Florida Department of Highway Safety and Motor Vehicles (DHSMV).

An alternative form that may relate to this is Form HSMV 85004, which is the Traffic Crash Report - Florida. While Form HSMV 84901 pertains to reporting violations or offenses related to motor vehicles, Form HSMV 85004 is used to report traffic crashes in Florida.