Form Dmv-54 - Preliminary Interest Application For Special Plate, Wv Kids Cancer Crusaders, Childhood Cancer Awareness

Download a blank fillable Form Dmv-54 - Preliminary Interest Application For Special Plate, Wv Kids Cancer Crusaders, Childhood Cancer Awareness in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Dmv-54 - Preliminary Interest Application For Special Plate, Wv Kids Cancer Crusaders, Childhood Cancer Awareness with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

DMV-54
07/15
DEPARTMENT OF TRANSPORTATION
DIVISION OF MOTOR VEHICLES
PO BOX 17120
CHARLESTON, WV 25317
Preliminary Interest Application for Special Plate
WV Kids Cancer Crusaders
Childhood Cancer Awareness
PART I - TO BE COMPLETED BY APPLICANT
Name of Applicant _____________________________________________________________
Name(s) of owner(s) exactly as shown on current registration for vehicle you wish to register:
Name(s)
Telephone Number
Present Street Address
Current License Plate Number
City
State
Zip
Title Number
Model Year
Make
Vehicle Identification Number
INSURANCE INFORMATION
Effective date of Insurance Policy: From
To ____________________ NAIC#______________
Name of Insurance Company____________________________________________________________________________
Agent__________________________________________________ Policy Number________________________________
I hereby state that there is a motor vehicle liability policy in effect on the described vehicle in accordance with provisions of the West
Virginia Motor Vehicle Laws and certify that the statements made are true and correct to the best of my knowledge and belief under penalty of
false swearing, West Virginia Code §17A-9-1; Fraudulent Applications.
Date ______________________
Signature of Applicant
PART II – CERTIFICATION OF ELIGIBILITY BY ORGANIZATION
The WV Kids CC certifies that the above named applicant is eligible to receive a special organization plate.
Date
__________________________________________
_________________________
Signature of qualifying official
__________________________________________
Printed name of qualifying official
PLEASE SEE REVERSE SIDE FOR INSTRUCTIONS

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form Dmv-54-hba - Preliminary Interest Application For Special Plate Form Dmv-54-hba - Preliminary Interest Application For Special Plate Legal
Application For Special Plates And Decals Tc142 Application For Special Plates And Decals Tc142 Financial
Form Tc-142 Application For Special Plates And Decals Form Tc-142 Application For Special Plates And Decals Financial
Form Tc-142 - Application For Special Plates And Decals Form Tc-142 - Application For Special Plates And Decals Financial
Application For Special Parking Permit Or License Plates For A Physically Disabled Person Form 2000 Application For Special Parking Permit Or License Plates For A Physically Disabled Person Form 2000 Legal
Form Dmv-54-ca - Contractors Association Of West Virginia Form Dmv-54-ca - Contractors Association Of West Virginia Legal
Form Mv-95 - Application For Special License Plate Form Mv-95 - Application For Special License Plate Legal
Form Mv-904sp - Application For Special Organization Registration Plate Form Mv-904sp - Application For Special Organization Registration Plate Legal
Form Mv-904sp - Application For Special Organization Registration Plate - Completed By Nra Foundation Form Mv-904sp - Application For Special Organization Registration Plate - Completed By Nra Foundation Legal
Form Mv-904sp - Application For Special Organization Registration Plate Form Mv-904sp - Application For Special Organization Registration Plate Legal

Related Categories

Parent category: Legal
Download
Go
Page of 2