Form Of Application For Farmland Preservation Plate-Agricultural Farmland Preservation

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APPLICATION FOR FARMLAND PRESERVATION PLATE
OFFICE USE ONLY
ASSIGNED # _____________
PLEASE PRINT OR TYPE
Owner’s Name ______________________________________________________________________
Address
_____________________________________________________________________
(Street)
_____________________________________________________________________
(City)
(State)
(Zip Code)
Is this a new address:
Yes
No
Daytime Phone # _____________________________
What is your current License Plate Number or Vanity Plate? __________________________________
Vehicle Registered Weight? _______________________
Year? _________________________
Manufacturer? ____________
Vehicle Identification Number? _______________________________
I understand the Farmland Preservation Plate is to be displayed only on the vehicle described above.
Owner’s Signature ________________________________
Date __________________________
(Please mail the $50 Check/money order (made payable to DE Division of Motor Vehicles) and this
completed application to DMV Administration Office, Special Tag, P O Box 698, Dover, DE 19903
Office Use Only
Date Received __________________________
Date Processed ________________________
Date Mailed ____________________________
Employee Name _______________________

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