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Form Mv-Afv - Application And Verification For Issuance Of An Alternative Fuel License Plate

Application and Verification for Issuance

of an Alternative Fuel License Plate

Applicant’s Full Legal Name:

Applicant’s Residence Address Including City, State & Zip Code:

County of Residence:

Daytime Telephone Number Including Area Code:

Owner’s Driver’s License Number:

Make and Model of Vehicle

Year

Vehicle Identification Number

(V.I.N.)

An Alternative Fueled vehicle is any vehicle fueled by an alternative fuel, as described in O.C.G.A. §40-2-76

(a)(2)(A) or (B).

Please check below the alternative fuel license

Brand of Fuel (except Electricity or Solar Energy):

type & location where you intend to purchase such

fuel.

Compressed Natural Gas (CNG) or

Fuel will primarily be purchased in:

Propane (LPG)

City

County

Ethanol (E85)

Electricity or Solar Energy

Applicants Verification of Information Provided

By signing this application, you are affirming that you:

1. Own and operate an approved alternative fuel vehicle

2. Will purchase approved alternative fuel primarily at the location indicated on this application

3. Will operate this vehicle on the alternative fuel checked above not less than 85% of the total time the

vehicle is in operation.

By signing this application you are affirming, under penalties of false swearing, that the statement and answers

made by you are true and correct, and that if there are any change in the facts represented on this application

you shall immediately surrender the license plate to your county tag office or your registration shall be revoked.

Applicant’s Signature:

Date:

Revision 07/08

MV-AFV application

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Form Mv-Afv - Application And Verification For Issuance Of An Alternative Fuel License Plate