Transcription of Application for Substitute Plates/Stickers/Moped Motor ...
1 Substitute Plates with stickers $ Use Only: Gratis Substitute Sticker or Moped Motor -Scooter Off-Road Vehicle Decal$ Duplicate/Additional Registration Card Only.$ (Registration card is issued with plates and stickers ) I am applying for: Substitute plates with stickers Substitute year sticker only Substitute month sticker only (No fee required) Duplicate Registration Card Additional Registration Cards. Reason: plate # Validation Sticker # Exp. DateFee Title #Exceptions Year Make Body StyleClass Vehicle Identification Number Owner's Name Owner s Driver's license # Co-Owner's Name Co-Owner s Driver's license # Owner's Street AddressCityCountyState Zip Code Name of Insurance CompanyAgent or BrokerPolicy/Binder # I/We certify, under penalty of perjury, that the statements made herein are true and correct and the vehicle described above is covered by the minimum amounts of insurance as required by law.
2 Signature of OwnerDate Signature of Co-Owner Date ID:Approved by: Substitute decal for Moped/ Motor -Scooter/Off-Road Vehicle(Specialty plate fees are on the back)Decal # Motor Vehicle Administration6601 Ritchie Highway, Burnie, Maryland 21062 For more information, please call: 410-768-7000 (to speak with a customer agent).TTY for the hearing impaired: 1-800-492-4575. Visit our website at: (03-14) Application for Substitute Plates/Stickers/Moped Motor -Scooter Off-Road Vehicle Decal/Duplicate Registration CardApply to register to vote with your driver s license transaction. For details ask your customer service Vote Now!Apply the face of this Application in detail. All information requested is necessary in order to process your request.
3 A copy of the registered owner s driver s license must accompany this Application . If your original plate (s)/sticker(s)/moped, Motor -scooter, off-road vehicle decal or registration card has become lost, stolen or mutilated, check the proper block and give reason for applying for replacement plate (s)/sticker(s)/moped, Motor -scooter, off-road vehicle decal or registration will be an additional fee for the substitution of specialty plates, even if they have been reported stolen. Organization/Organization Logo plates have a $ or $ fee respectively. Personalized and Ham Radio Operator plates have an additional $ you desire an additional registration card, check the proper block. The fee is five dollars ($ ) for each one owner is required to sign the Application .
4 If the vehicle is company-owned, the person signing the Application must list their official capacity. If you are not a company official, do not own the vehicle or you haveleased the vehicle, a power of attorney certificate must accompany the do not send cash. Make check or money order payable to Motor Vehicle Administration. The check must include(1) Imprinted Name and Address, (2) Drivers license Number (Soundex Number), (3) Home and/or WorkPhone may either mail your Application with appropriate fees to: Motor Vehicle Administration - Registration Renewal Section6601 Ritchie Highway, Burnie, Maryland 21062 orVisit your local MVA full service office and have your plate (s)/sticker(s)/moped, Motor -scooter, off road vehicle decal or registration card issued to assistance, please call 410-768-7000, TTY for the Hearing Impaired: 1-800-492-4575.
