STATE OF FLORIDA

STATE OF FLORIDADEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLESDIVISION OF MOTOR VEHICLESAPPLICATION FOR PERSONALIZED LICENSE PLATEINSTRUCTIONS ARE INDICATED ON REVERSE SIDEDate of Application_____Please contact your Local County Tax Collector's Office, License Plate Agencyor refer to the reverse side of this form for fee / APPLICANT IDENTIFICATIONO wner s Name_____ Owner s Sex_____ Date of Birth_____ (For company, show C for sex) (For company, show expiration date)Street Address _____ FEID # _____City_____ STATE _____ Zip _____1st Owner D/L Number_____ 2nd Owner D/L Number _____Lessee s Name_____ Lessee s Sex _____ Date of Birth _____(For company, show C for sex) (For company, show expiration date)Street Address_____ FEID # _____City_____ STATE _____ Zip _____1st Lessee's D/L Number_____ 2nd Lessee's D/L Number _____VEHICLE INFORMATIONC urrent Decal Number_____ Current License Plate Number_____ Vehicle Type_____Vehicle Make_____ Year_____ Color_____ Vehicle Weight_____Title Number_____ Vehicle Identification Number _____CERTIFICATIONThis is to certify that I am th

state of florida department of highway safety and motor vehicles ... nova southeastern university ** palm beach atlantic university ** ... eckerd college* florida hospital college of health sciences* 7 $56.60 florida professional sports team: florida marlins ** florida panthers **

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  Health, Department, Florida, Florida department, Lamp, Beach, Of health, Palm beach

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