Form Mv-414 - I Love Ny Adventure Custom Plates Page 2
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FILL IN INFORMATION BELOW (Please Print):
Last Name
First
MI
Mailing Address (Street & No., Apt. No.)
City
State
Zip Code
Daytime Phone No.
Date of Birth
DEC Lifetime License ID Number (if applicable) DMV Driver License ID Number
/
/
(
)
Signature (Sign Name in Full)
Date
-
Current Plate Number
Vehicle Year
Vehicle Make
If you need the International Symbol of Access on your new plates and you do not have it on your current plates,
Do your current plates have the
o
o
you must also submit a completed form MV-664.1
International Symbol of Access?
Yes
No
DETERMINE YOUR FEE USING THE CHART ON PAGE 1
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}
Amount Enclosed
I am paying by:
$
o
Check
o
Money Order
o
}
American Express
o
Discover
o
Master Card
o
Visa
CERTIFICATION:
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By signing below, I certify that I hold a current DEC License and/or Parks Empire Passport and that I am entitled to pay the appropriate fee as
stated on the chart on Page 1 of this application. I acknowledge and understand that making a false statement in this or in any registration ap-
plication or in any proof or statements in connection with it is a misdemeanor or felony under Section 392 of the Vehicle and Traffic Law and/or
under the Penal Law, and may result in the revocation or suspension of my registrations and/or my license, and/or criminal prosecution.
-
_________________________________________________________
____________________
Signature
Date
NOTE:
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Please allow 4 to 6 weeks for delivery.
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Unless a personalized plate is being requested, the next available number in the plate series will be assigned.
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Falsifying documents will result in cancellation of the custom plates.
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Plates will be mailed to the address on the vehicle’s registration file. If you have moved and you have not updated your
address on your registration record, please complete the Change of Address form MV-232.
If you have any questions, or need additional information, call 518-402-4838.
--- dmv.ny.gov/custom-plates/looking-information-custom-plates ---
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MV-414 (3/15)
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