Fillable Form Cp-30 - Application For Custom Plates printable pdf download

APPLICATION FOR CUSTOM PLATES

This form is used to apply for custom plates that cannot be ordered on our website. For a complete list of all of our plates, pricing

information, and eligibility requirements, please visit our website at dmv.ny.gov/nav/custom-plates.

PLEASE PRINT INFORMATION BELOW

Which plate are you applying for? (Refer to the list with eligibility and fee information on our website dmv.ny.gov/nav/custom-plates.)

Last Name

First

M.I.

Date of Birth (Month/Day/Year)

Address (Include Street Number and Name and/or Rural Delivery Box No.)

check if new Apt. #

City

State

Zip Code

Signature (Sign Name in Full)

Date

Daytime Phone (include area code)

(

)

Vehicle Model Year

Vehicle Make

Current Plate Number

Plate type:

Passenger

Commercial

Motorcycle

If you need the Symbol of Access on your new plates and you do not have it on your current plates,

Do your current plates have the Symbol of Access?

Yes

you must also submit a completed form MV-664.1, which may be printed from the DMV website.

I WOULD LIKE TO APPLY FOR:

(number assigned by DMV)

Standard plates

(Passenger Plates, Commercial Plates or Motorcycle Plates)

Personalized plates

Check our website for exact space allowances and configuration restrictions. You may provide up to three letter/number

combination choices. To show a space, put a period (.) on the line in the choice where you want the space. DMV reserves

the right to reject, recall or cancel any plate that is deemed objectionable. This includes plates that have already been

issued.

1st

2nd

3rd

you must qualify).

(

Symbol of Access Requested

If the Symbol of Access is required, four or five spaces are allowed.

Making a false statement in any registration application or in any proof of statements in connection with it, or deceiving or

IMPORTANT:

substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in

the revocation or suspension of the registration and/or the applicant’s license pursuant to regulations established by the Commissioner. The

act of renewing these plates shall constitute your certification that you remain eligible to continue holding these plates.

PAYMENT METHOD:

Check

Money Order

Amount Enclosed $

Make check or money order payable to “Commissioner of Motor Vehicles”.

Credit Card:

American Express

Discover

Master Card

Visa

Name (as it appears on credit card)

Credit Card Number

Expiration Date

Authorized Signature

Please allow 4 to 6 weeks for delivery. If annual custom plate fees apply, they will be included in your registration renewal.

Return this completed form, the required proof if needed, and payment to:

Department of Motor Vehicles, Custom Plates Unit, PO Box 2775, Albany, NY 12220-0775

Custom Plates Unit (518) 402-4838:

M-F 8:00am - 4:00pm

CLEAR

CP-30 (12/17)

Form Cp-30 - Application For Custom Plates

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