Form Mvd-356dealer Family Plate Application-Bureau Of Motor Vehicles Form
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1Bureau of Motor Vehicles
Application for a Dealer Family Plate
(New, Used or Motorcycle Dealer Only)
(A separate application must be completed for each owner)
Type:
NEW CAR
USED CAR
MOTORCYCLE
Legal Dealership Name: ______________________________________________ Phone: _________________________
DBA (if applicable): ________________________________________________________________________________
Business Physical Location: __________________________________________________________________________
(Street)
(City/Town)
(Zip)
Owner’s Name: ____________________________________________________________________________________
Owner’s Home Address: ______________________________________________________________________________
(Street)
(City/Town)
(Zip)
Only one family plate per owner. If an owner has ownership in any other dealership, he/she is allowed only one family plate
regardless of the number of dealerships owned. A family plate may be attached only to a vehicle in the dealer’s active inventory
for resale. A family plate may be used only by a spouse or child under the age of 19 residing full-time in the owner’s residence
and may be used only for personal use, not for employment.
Type of Plate
Plate Fee
License # (Plate #)
New Car Family
$ 20
(D)
New Car Vanity Family
$ 50
(D)
Used Car Family
$ 20
(UC)
Used Car Vanity Family
$ 50
(UC)
Motorcycle Family
$ 5
(M)
Total Amount
$
Please list the family member in which the family plate will be assigned to:
________________________________________________ Date
________________________
Name:
of Birth:
_____________________________________________________________________________
Home Address:
(Street)
(City/Town)
(Zip)
Spouse or
Child (
Relationship to Owner:
child under the age of 19 residing full-time in the owner’s residence)
Make check or money order payable to the Secretary of State. Please mail to: Bureau of Motor Vehicles, Dealer Licensing,
101 Hospital Street, 29 State House Station, Augusta ME 04333.
Or
VISA
or
MASTERCARD
Application may be faxed to:
Payment may be made by credit card:
207) 624-9126
(
Credit card number: ____________________________________________________________
Expiration date: _______________________________________________________________
Cardholder’s name: ____________________________________________________________
_____________________________________________________________________________________________________________
Signature of Owner
Date
BMV USE ONLY
SE ONLY
Date initial license issued: _____________________________
____________________
Date initial license issued:
Number of sales for renewal year: _______________________
______________
Number of sales for renewal year:
Approval for family plate by:_____________ Date: _________
Approval for family plate by:________ Date: _______
Denial for family plate by: _______________ Date: _________
Reason for denial:____________________________________
Denial for family plate by: __________ Date: _______
____________________________________
Reason for denial:_____________________________
MVD-356 Rev 04/2016
101 Hospital Street, 29 State House Station, Augusta, Me 04333-0029 Tel. (207) 624-9000 Ext. 52143 Fax: (207) 624-9126 TTY Users call Maine relay 711
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