Special (Vanity) Plate Application - Vermont DMV

1 Special ( vanity ) Plate Application DEPARTMENT OF MOTOR VEHICLES Agency of Transportation 120 State Street Montpelier, Vermont 05603-0001 Toll Free: 888-99- Vermont TTD: 711 VD-017 5M 08/2017 MTC If you are requesting a Conservation Plate please use form VD-154, for Building Bright Futures Plate please use form VD-102. Name & Address Last Name First Name Middle Initial License # Mailing Address( Where you get your mail) City State ZIP Code Physical Address City State ZIP Code Email Phone Vehicle Current Plate No. Make Model Year Body Type Serial Number (VIN) See instructions for restrictions. This is not a valid document until your request is approved.

2 Example 1st Choice * V R M N T * 2nd Choice * M Y C A R * 3rd Choice S K I * B U M Plate Choice 1st Choice 2nd Choice 3rd Choice Statements and warrant made herein are certified under penalty of 23 202 & 203. Signature of Applicant Date DO NOT WRITE BELOW - DMV USE ONLY Special Plate # Audit Line: Exp. Date Vehicle Type = Style = N Code Temp Issued? Temp Plate No Special ( vanity ) Plate Application DEPARTMENT OF MOTOR VEHICLES Agency of Transportation 120 State Street Montpelier, Vermont 05603-0001 Toll Free: 888-99- Vermont TTD: 711 If you are requesting a Conservation Plate please use form VD-154, for Building Bright Futures Plate please use form VD-102.

3 Name & Address Last Name First Name Middle Initial License # Mailing Address( Where you get your mail) City State ZIP Code Physical Address City State ZIP Code Email Phone Vehicle Current Plate No. Make Model Year Body Type Serial Number (VIN) See instructions for restrictions. This is not a valid document until your request is approved. Example 1st Choice * V R M N T * 2nd Choice * M Y C A R * 3rd Choice S K I * B U M Plate Choice 1st Choice 2nd Choice 3rd Choice Statements and warrant made herein are certified under penalty of 23 202 & 203. Signature of Applicant Date DO NOT WRITE BELOW - DMV USE ONLY Special Plate # Audit Line: Exp.

4 Date Vehicle Type = Style = N Code Temp Issued? Temp Plate No INSTRUCTIONS 1. Complete sections 1 and 2 of the Application . If the Application is not properly completed, it will be returned to you. All information must be printed in ink or typed. 2. Application must be signed by the registered owner. Signature must be in ink. 3. A combination of letters, numbers or spaces may be used. No more than two (2) numbers are allowed in combination with letters. The letter O is considered to be a number (zero). Dots, dashes or other Special characters or symbols cannot be used. The Plate cannot begin with the letter Z . A single letter Plate is acceptable; however, the letter cannot be an I , J , O or Z.

5 Use asterisks (*) to indicate spaces where desired. If no asterisks (*) are used, the characters will be centered on the Plate . 4. A maximum of seven (7) characters may be used. Exceptions: a. Moped, motorcycle and small trailer plates are limited to maximum of (6) characters. b. Handicapped plates are limited to a maximum of five (5) characters. c. Antique and Exhibit plates are limited to a maximum of four (4) characters. 5. If the vehicle indicated in Section 1 is currently registered in Vermont only the Special Plate fee is due. If the vehicle is not currently registered in Vermont , complete a Registration, Tax and Title Application (VD-119). Submit all fees for registration and this Application .

6 6. Special plates are issued under the following conditions: a. No prior request has been received for the same combination. b. For any vehicle type except dealer, transporter, Veteran and service & safety organizations. c. A separate Application must be made for plates for each vehicle. d. vanity number plates, whether new or renewed, shall be issued in any combination or succession of numerals and letters, provided the total of the numbers and letters on any Plate taken together does not exceed seven, and further provided the requested combination of letters and numerals does not duplicate or resemble a regular issue registration Plate . e. The Commissioner may revoke any Plate described in this subsection and shall not issue plates with combinations of letters or numbers that objectively, in any language: are vulgar, scatological, or obscene, or constitute racial or ethnic epithets; connote breast, genitalia, pubic area, or buttocks or relate to sexual or eliminatory functions; refer to any intoxicant or drug; to the use, nonuse, distribution, or sale of an intoxicant or drug; or to a user, nonuser, or purveyor of an intoxicant or drug; refer to gender, gender identity, sexual orientation, or disability status; suggest a government or governmental agency.

7 Suggest a privilege not given by law in this State; or form a slang term, abbreviation, phonetic spelling, or mirror image of a word described in subdivisions (1) through (6) of this subsection. NOTE: The Commissioner of Motor Vehicles has the authority to revoke plates issued in error. 7. A Vehicle not displaying a valid Vermont Inspection sticker must be inspected within 15 days of registration. 8. Delivery of Special Plates may take up to 30 days from the date your request is approved.