Form Mv-165 - Application For A Vertical Motorcycle Registration Plate
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2MV-165 (1-15)
APPLICATION FOR A VERTICAL
www dmv state pa us
MOTORCYCLE REGISTRATION PLATE
For Department Use Only
Bureau of Motor Vehicles • 1101 S. Front Street - Harrisburg, PA 17104-2516
NOTE: A vertical motorcycle registration plate may only be displayed vertically.
A
VEHICLE DESCRIPTION AND APPLICANT INFORMATION
(Complete this section exactly as information appears on current registration card.)
Title Number
Vehicle Identification Number
Registration Plate Number
Make of Vehicle
Year
Expiration Date
Last Name (Or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Co-Owner Last Name
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
City
State
Zip Code
Street Address
Telephone Number: _______________________________________________________ Work _______________________________________________________
NOTE: In conjunction with replacement of your plate, you will receive one registration card. If additional registration cards are desired,
the fee is $2 for each card. Number of Duplicate Registration Cards Requested @ $2 each _________.
B
OPTIONAL PERSONALIZATION REQUEST (NOTE: Additional $100 Fee Required.)
Vertical Motorcycle personalized registration plate choices may contain up to FIVE letters or numbers in combination. ONLY one
hyphen or space is permitted but not both. (The hyphen or space is counted as one of the five allotted spaces.) No other special
characters are available. Please print clearly. Additional instructions are listed on the reverse side of this application.
FIRST CHOICE
SECOND CHOICE
THIRD CHOICE
C
APPLICANT SIGNATURE(S)
I/We hereby certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that
any misstatement of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year
(18 Pa.C.S. Section 4904[b]).
Owner/Lessor Signature
Co-Owner Signature
Date
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