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APPLICATION FOR PERSONALIZED LICENSE PLATE

STATE OF florida . DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF MOTORIST SERVICES. SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE. APPLICATION FOR PERSONALIZED LICENSE PLATE . INSTRUCTIONS ARE INDICATED ON REVERSE SIDE Date of APPLICATION _____. PLEASE CONTACT YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE, LICENSE PLATE AGENCY. OR REFER TO THE REVERSE SIDE OF THIS FORM FOR FEE INFORMATION. OWNER / APPLICANT IDENTIFICATION. Owner's / Lessee's Name: Sex: Date of Birth: Street Address: City: State: Zip: Owner's / Lessee's D/L Number: Owner's / Lessee's E-mail Address: FEID#: Co-Owner's / Co-Lessee's Name: Sex: Date of Birth: Street Address: City: State: Zip: Co-Owner's / Co-Lessee's D/L Number: Co-Owner's / Co-Lessee's E-mail Address: FEID#: VEHICLE INFORMATION.

state of florida department of highway safety and motor vehicles – division of motorist services submit this form to your local tax collector office

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