PERSONALIZED/SPECIAL PLATE REQUEST MOTOR VEHICLE …

1 PERSONALIZED/SPECIAL PLATE REQUEST MOTOR VEHICLE DIVISION. ND DEPT OF TRANSPORTATION. North Dakota Department of Transportation, MOTOR VEHICLE 608 E BOULEVARD AVE. SFN 53612 (1-2020) BISMARCK ND 58505-0780. Telephone (701) 328-2725. Fax (701) 328-1487. Website: Legal Name of Owner (Last, First, Middle) Telephone Number Mailing Address City State Zip Code VEHICLE Information Title Number VEHICLE Identification Number Current License PLATE Number PLEASE MAKE SURE ALL LETTERS ARE CAPITALIZED AND NUMBERS ARE WRITTEN CLEARLY. First Choice: Second Choice: Meaning of PLATE (Required for new and reorders) Meaning of PLATE (Required for new and reorders). personalized PLATE and other applicable fees are in addition to the registration fee. Please check type of PLATE : Antique Motorcycle - $100 one-time personalized PLATE fee - (maximum 6 characters). Antique Passenger and Truck - $100 one-time personalized PLATE fee - (maximum 7 characters).

2 collector - $160 one-time personalized PLATE fee - (maximum 7 characters). SFN 16783 (Affidavit of Use for a collector MOTOR VEHICLE ) must be completed and enclosed. FFA Foundation PLATE - $10 one-time fee + $25 personalized PLATE fee - (maximum 5 characters). Firefighter - $40 yearly fee ($15 Firefighter fee + $25 personalized PLATE fee) - (maximum 5 characters). SFN 52908 (Application for North Dakota Firefighter's PLATE ) must be completed and enclosed. Gold Star PLATE - (maximum 5 characters) Certification of eligibility from the North Dakota State Department of Veterans Affairs must accompany this form. National Guard - $5 (NG) one-time fee + $25 personalized PLATE fee - (maximum 4 characters). Verification from Adjutant General's Office must be enclosed. Off Highway PLATE - $45 bi-annual fee ($20 registration + $25 personalized PLATE fee) - (maximum 5 characters). Organization PLATE - $50 yearly fee ($25 Organization PLATE fee + $25 personalized PLATE fee) - (maximum 5 characters).

3 Specify Organization Patriotic PLATE - $50 yearly fee ($25 Patriotic PLATE fee + $25 personalized PLATE fee) - (maximum 5 characters). Check One: Boonie Stomper United States Flag Bald Eagle personalized PLATE - (all other types) - $25 yearly fee - (maximum 7 characters) (Motorcycle - maximum 6 characters). Except the following (maximum of 6 characters) Mobility-Impaired Prisoner of War PLATE - (maximum 7 characters) Certification of eligibility from the North Dakota State Department of Veterans Affairs must accompany this form. Unconventional - $75 annual fee ($50 registration + $25 personalized PLATE fee) - (maximum 5 characters). Veteran PLATE - $40 yearly fee ($15 Veteran fee + $25 personalized PLATE fee) - (maximum 5 characters). SFN 51628 (Application for North Dakota Veterans Number PLATE ) must be completed and enclosed. Check One: Air Force Army Coast Guard Marines Navy Purple Heart Non-branch Signature of Owner Dat