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www.dmv.pa.gov APPLICATION FOR PERMANENT ANTIQUE, …

Check (4) block below to indicate type of registration plate desired as defined on the reverse side of this form:qANTIQUEqclAssicqcOllEcTiblE -The vehicle must be currently branded as a collectible vehicle or the vehiclemust follow procedures as outlined in Form APPlicANT(s) iNfOrmATiONb vehicle DEscriPTiON AND gENErAl iNfOrmATiONc cOllEcTiblE vehicle iNfOrmATiONE sElf-cErTificATiON AND sigNATurED OPTiONAl PErsONAliZATiON rEquEsT (NOTE:additional $104 Fee Required.)Last Name (or Full Business Name)Street addressCityStateZip CodeFirst NameMiddle NameDaytime Telephone NumberDescribe in detailhow the vehicle has been modified to qualify as a collectible vehicle as defined on the reverse side of this form. all engine andexhaust system modifications must be described in detail and two additional color photographs are required. One photo of the engine compartmentthat shows the qualifying engine modifications and the other of the exhaust system that shows the modified changes or the new exhaust system thatwas installed must be included.

q ANTIQUE q CLASSIC q COLLECTIBLE - The vehicle must be currently branded as a collectible vehicle or the vehicle -426B. A APPLICANT(S) INFORMATION B VEHICLE DESCRIPTION AND GENERAL INFORMATION C COLLECTIBLE VEHICLE INFORMATION E SELF-CERTIFICATION AND SIGNATURE D OPTIONAL PERSONALIZATION REQUEST - NOTE: additional $112 fee required.

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Transcription of www.dmv.pa.gov APPLICATION FOR PERMANENT ANTIQUE, …

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