Application for Custom Plates - New York State Department ...
APPLICATION FOR CUSTOM PLATES
This form is used to apply for custom plates that cannot be ordered on our website. For a complete list of all of our plates, pricing information, and eligibility requirements, please visit our website at dmv.nav/custom-plates. If eligibility certification is required, mail it with this form.
PLEASE PRINT INFORMATION BELOW
Which plate are you applying for? (Refer to the list with eligibility and fee information on our website dmv.nav/custom-plates.)
Last Name
First
Address (Include Street Number and Name and/or Rural Delivery Box No.)
check if new Apt. # City
M.I. Date of Birth (Month/Day/Year)
/
/
State Zip Code
Signature (Sign Name in Full)
X
Current Plate Number
Do your current plates have the Symbol of Access?
Date
/
/
Plate
Vehicle Model Year
o o o type:
Passenger
Commercial
Motorcycle
Daytime Phone (include area code)
(
)
Vehicle Make
o o Yes
No
If you need the Symbol of Access on your new plates and you do not have it on your current plates, you must also submit a completed form MV-664.1, which may be printed from the DMV website.
I WOULD LIKE TO APPLY FOR:
o Standard plates (number assigned by DMV)
o Personalized plates (Passenger Plates, Commercial Plates or Motorcycle Plates)
Check our website for exact space allowances and configuration restrictions. You may provide up to three letter/number combination choices. Use a period (.) on the line in the choice where you want the space. DMV reserves the right to reject, recall or cancel any plate that is deemed objectionable. This includes plates that have already been issued.
Excelsior
Plates: 1st
2nd
3rd
Picture
Plates: 1st
2nd
3rd
o Symbol of Access Requested (you must qualify). If the Symbol of Access is required, four or five spaces are allowed.
IMPORTANT: Making a false statement in any registration application or in any proof of statements in connection with it, or deceiving or substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in the revocation or suspension of the registration and/or the applicant's license pursuant to regulations established by the Commissioner. The act of renewing these plates shall constitute your certification that you remain eligible to continue holding these plates.
PAYMENT METHOD:
o Check o Money Order
Make check or money order payable to "Commissioner of Motor Vehicles".
Credit Card: o AmericanExpress o Discover o Master Card o Visa
Name (as it appears on credit card)
Credit Card Number
Authorized Signature X
Expiration Date
SecurityCode
3 or 4 digit code on the back or front of your card
Please allow 4 to 6 weeks for delivery. If annual custom plate fees apply, they will be included in your registration renewal.
CP-30 (9/20)
Return this completed form, the required proof if needed, and payment to:
Department of Motor Vehicles, Custom Plates Unit, PO Box 2775, Albany, NY 12220-0775
Custom Plates Unit (518) 402-4838: M-Th 8:00am - 4:00pm Become an Organ Donor! Visit donatelife.
CLEARR
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