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www.dmv.pa.gov APPLICATION FOR TEMPORARY …

APPLICANT MUST SIGN BELOW. I/We hereby make APPLICATION for TEMPORARY registration plates andcertify under penalty of law that ALL information contained herein isTRUE and CORRECT and that I/we understand that any misstatementof fact is a misdemeanor of the third degree punishable by a fine up to$2,500 and/or imprisonment up to 1 year (18 Section 4904[b]). _____Printed Name of Applicant Date_____Applicant Signature NO RUBBER STAMPS ACCEPTED For Department Use OnlyBureau of Motor Vehicles PO Box 68620 Harrisburg, PA 17106-8620 PLEASE PRINT LEGIBLY OR TYPEWRITE ALL INFORMATION - Amt. Credit Used $ + Shipping and Handling1 to 50 plates = $7$51 plates and up = $12 = Amt.

• If registration plates are to be picked up at PennDOT, please complete the above authorization. ( ) Name of Online Registration Integrator Business Phone Number MV-351 (12-21) www.dmv.pa.gov APPLICATION FOR TEMPORARY REGISTRATION PLATES BY MOTOR VEHICLE DEALERS AND FULL AGENTS

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