Form Mv-95 - Application For Special License Plate

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South Carolina Department of Motor Vehicles
MV-95
Revised
APPLICATION FOR SPECIAL LICENSE PLATE
1-7-07
To Apply:
1. Indicate the plate you desire and complete the application information.
2. Provide any required certifications and fees. (See the back of this form for a complete list of requirements.)
3. Mail your application to S.C. Department of Motor Vehicles, P.O. Box 1498, Blythewood, S.C. 29016-0008.
• DMV Special Plates can be viewed by visiting the DMV website at
• The plates are for cars or light trucks with an empty weight of 9,000 pounds or less and a gross vehicle weight of
11,000 pounds or less.
• Depending on your present expiration date, an updated tax receipt and additional fees may be required.
• Some applications for special plates must be mailed to the Department.
• If you no longer meet the requirements for the special plate, you must return it to your local DMV office.
• Registration Fees are as follows:
Passenger Cars - $24.00
Light Trucks GVW Fees:
0001-4000
$30.00
7001-8000
$80.00
4001-5000
$40.00
8001-9000
$90.00
5001-6000
$60.00
9001-10,000
$100.00
6001-7000
$70.00
10,001-11,000
$110.00
• Senior Citizen Fees are as follows: Cars - $20.00 (age 65)
$22.00 (age 64)
Light trucks with a GVW of no more than 6,000 lbs. fees are $30.00.
APPLICANT INFORMATION
Type of Special Plate Requested
Total Fees Included with Application
$
If you are requesting a College or University Plate, specify school:
Last Name
First Name
M.I.
Street Address
Mailing Address
City
State
Zip Code
(Area Code) Telephone Number
Vehicle Identification Number
Make
Year
Vehicle Plate Number
Do you wish to donate $1.00 to Donate Life South Carolina?
Yes
No
Amount $
INSURANCE INFORMATION
Under penalties of perjury, I declare this vehicle is insured with the company named below and I will maintain
liability insurance throughout the registration period.
Name of Insurance Company
CERTIFICATION
I certify all information provided in this application is true and correct.
Signature of Applicant
DMV USE ONLY
Check No.
Amount $
Plate No.
Clerk Initials

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