OHIO BUREAU OF MOTOR VEHICLES



|[pic] |OHIO DEPARTMENT OF PUBLIC SAFETY | |

| |BUREAU OF MOTOR VEHICLES | |

| | | |

| |APPLICATION FOR SENIOR, TEMPORARY FARM | |

| |AND CAMP BUS LICENSE PLATES | |

| |

|You MUST CHECK THE TYPE of new plate requested or your application cannot be processed. |

| |

| SENIORS BUS | TEMPORARY FARM BUS | CAMP BUS |

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|TYPE OR PRINT |INSTRUCTIONS ON BACK |

|REGISTRATION INFORMATION FOUND ON OHIO REGISTRATION CARD |

|OHIO LICENSE PLATE # |EXPIRATION DATE | |

|      |      | |

|VEHICLE INFORMATION FROM OHIO CERTIFICATE / MEMORANDUM TITLE |

|DATE VEH PURCHASED |VEH YEAR |VEH MAKE |VEH TYPE |VEH COLOR |

|      |      |      |      |      |

|VEH SERIAL # |CERTIFICATE OF TITLE # |# OF PLATES REQUESTED |

|      |      |1 2 |

|OWNER INFORMATION |

|OWNER NAME |DAYTIME PHONE # |TIN |

|      |      |      |

|OHIO ADDRESS |CITY |STATE |ZIP CODE |

|      |      |OH |      |

|E-MAIL ADDRESS |

|      |

|VEHICLE OWNERSHIP |JOINT OWNER / LESSEE NAME |SSN OR TAX ID # |OHIO COUNTY OF RESIDENCE |

|SINGLE JOINT LEASED COMPANY |      |      |      |

|OWNER BUSINESS ADDRESS |CITY |STATE |ZIP CODE |

|      |      |      |      |

|Is your license plate registration under suspension or revocation under Ohio Financial Responsibility Law? |

|YES NO |

|IF PLATE(S) ARE TO BE MAILED TO A DIFFERENT ADDRESS FROM THAT SHOWN ABOVE, FILL IN THE FOLLOWING |

|ADDRESS |CITY |STATE |ZIP CODE |

|      |      |      |      |

|PROOF OF FINANCIAL RESPONSIBILITY |

|YOU WILL LOSE YOUR DRIVER LICENSE IF YOU DRIVE WITHOUT INSURANCE OR OTHER FR PROOF |

|In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage. |

| |

|It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage. |

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|PROOF OF COVERAGE IS REQUIRED: • Whenever a police officer issues a traffic ticket • At all vehicle inspection stops • Upon traffic court appearances. |

| |

|ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: • Lose his or her driver license until requirements are met on first offense, ONE YEAR |

|on second offense and TWO YEARS on additional offenses • Lose his or her license plates and vehicle registration • Pay reinstatement fees of $40.00 for first offense, |

|$300.00 for second offense, $600.00 for third and subsequent offenses • Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or |

|registration AND • Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE |

|YEARS. |

| |

|ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated |

|for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be |

|permitted to register any motor vehicle in Ohio for FIVE YEARS. |

| |

|IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have • A SECURITY SUSPENSION for TWO |

|YEARS or more and • A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied). |

| |

|THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. |

| |

|WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. |

|WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: • AN INSURANCE POLICY showing automobile liability insurance of at least $25,000 bodily injury |

|per person, $50,000 injury two or more persons, and $25,000 property damage • AN INSURANCE IDENTIFICATION CARD (same coverage) • A SURETY BOND OF $30,000 issued by any |

|authorized surety company or insurance company • A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 • A BMV CERTIFICATE FOR MONEY in the amount of |

|$30,000 on deposit with the Registrar of Motor Vehicles • A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor |

|vehicles. |

|I affirm that the owners (or lessees of leased vehicle) now have insurance or other proof of financial responsibility (FR Proof) covering this vehicle and will not |

|operate or permit the operation of this vehicle without FR Proof; and will not be used as a commercial vehicle unless so registered. |

|APPLICANT SIGNATURE |DATE |

|X |      |

|WARNING: Applicant giving false information is subject to prosecution Ohio Revised Code (R.C.) 2913.42 |

|Application must be signed by the owner(s) as named on Certificate of Title. |

|CERTIFICATE OF TITLE AND / OR EPA INSPECTED BY: |DEPUTY REGISTRAR NAME/NUMBER |

|      |      |

|Your application will be processed and new plate(s) mailed within four weeks. Failure to follow instructions will delay the issuance of your license plate(s). |

| |

|NOTE: YOU MUST HAVE YOUR VEHICLE INSPECTED ANNUALLY BY THE HIGHWAY PATROL IF YOUR VEHICLE IS MANUFACTURED TO TRANSPORT MORE THAN 15 PASSENGERS, INCLUDING THE DRIVER, OR|

|HAS A GROSS VEHICLE WEIGHT THAT EXCEEDS TEN THOUSAND POUNDS. |

|INSTRUCTIONS |

|SENIOR BUS (R.C. 4503.04) |

|Below affidavit must be completed. |

|The owner of a bus used principally for the transportation of persons 65 years of age or older may obtain Seniors license plate(s). To qualify for Seniors bus |

|license plate(s), the bus must seat 10 or more. |

|TEMPORARY FARM BUS (R.C. 4503.04) |

|Below affidavit must be completed. |

|Temporary farm bus vehicle license plate(s) can be issued for a period of 310 days from the date of issue of the license plate(s) for the bus, for a fee of ten |

|dollars, provided such license plate(s) shall not be issued for more than any one such period in any calendar year. The bus will be used solely for the |

|transportation of agricultural employees, and used only in transportation of such employees as are needed in the operation of the farm. Statement must be completed |

|and signed by the owner(s) or lessee(s). |

|CAMP BUS (R.C. 4503.17) |

|Below statement and affidavit must be completed. |

|The owner of a school bus under contract with a board of education may use such bus during summer vacation periods to transport children and their authorized |

|supervisors to and from any camping function sponsored by a nonprofit, tax-exempt, charitable, or philanthropic organization. Certificate for school bus from State |

|Highway Patrol required. |

| |

|STATEMENT |

|OWNER OF BUS OR NAME OF SCHOOL BOARD |STREET ADDRESS |CITY |COUNTY |

|      |      |      |      |

|MAKE OF BUS |YEAR |SERIAL # |

|      |      |      |

| |

|(CAMP BUS) Name:       is under contract with this school board of education to transport school children either to and from school, or to and from any school |

|function. |

| |

|SIGNATURE |NAME OF SCHOOL BOARD OF EDUCATION (CAMP BUS) |DATE |

|X |      |      |

| |

|AFFIDAVIT MUST BE NOTARIZED |

|OWNER OF BUS |STREET ADDRESS |CITY |

|      |      |      |

|YEAR / MAKE |SERIAL # |SCHOOL BUS LIC #: (CAMP BUS) |

|      |      |      |

|NAME OF LESSEE |STREET ADDRESS |CITY |

|      |      |      |

| |

|Applicant being first duly sworn states that the bus described above has a seating capacity of 10 or more and (Check one) |

| Will be used principally for the transportation of persons 65 years of age or older. |

| Will be operated exclusively during the summer months to transport children and their authorized supervisors to and from any camping function sponsored by a |

|nonprofit, tax-exempt, charitable or philanthropic organization. |

| Will be used solely for the transportation of agricultural employees, and used only in the transportation of such employees as are necessary in the operation of the|

|farm, for a 310 day period, beginning with the effective date of Temporary Farm Bus registration. |

|SIGNATURE OF OWNER(S) OR LESSEE(S) |DATE |

|X |      |

|Notary: |

|Sworn to and subscribed in my presence this day of , 20 in County, |

|State of . |

|(Notary Seal) |

|Signature of Notary Public X My commission expires |

| |

|THE FOLLOWING ITEMS MUST BE RETURNED TO THE OHIO BMV TO REGISTER BY MAIL: |

|Total amount due. Make check or money order payable to: Ohio Treasurer of State, BMV, Add permissive tax to total due if applicable. |

|The R.C. 4503.19 requires that you ADD $7.50 for two (2) plates or $6.25 for one (1) plate to the above fees for replacement plate(s) if your vehicle is currently |

|registered or has been registered within the last 12 months. |

|Current OHIO vehicle registration card for above vehicle. Temporary tag registration or registration card which expired more than 11 months ago is unacceptable. If |

|registration card is unavailable, send Certificate of Title or Memorandum Title (original document only). |

|You may take these documents to any deputy registrar agency. The deputy will verify the vehicle information for a service fee. |

|Required documents as stated ABOVE (see instructions) for the type of registration being requested. |

|Affidavit and/or statement must be completed. |

|Completed and signed application. Mailing address on front. |

|If leased provide a copy of lease agreement. |

| |

|You are now permitted to donate $1.00 to the children’s Save Our Sight (SOS) Program by checking the appropriate box below and adding an additional $1.00 to your |

|total fees due. For more information on the children’s SOS Program, please call 1-800-755-GROW (4769). |

| Yes, I would like to donate to the children’s SOS Program. I have added $1.00 to the total fees due. |

| |

|OHIO BUREAU OF MOTOR VEHICLES, ATTN: REGISTRATION SUPPORT SERVICES |

|P.O. Box 16521, Columbus, Ohio 43216-6521, (614) 752-7518 |

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