Form Mv-82sta - State Vehicle Registration/title Application (Page 2 of 2) in pdf

Form Mv-82sta - State Vehicle Registration/title Application Page 2

REQUEST FOR EXEMPTION FROM USE OF STATE AGENCY MARKED LICENSE PLATES

gency Name:

Address:

STANDARD SERIES LICENSE PLATES ARE BEING REQUESTED FOR THE FOLLOWING VEHICLE:

The vehicle listed above qualifies for standard series license plates for the reason selected below (please initial the

applicable exception):

The vehicle is assigned to a state official of cabinet rank or to the head of a state entity.

The vehicle is primarily used for law enforcement or criminal investigative work.

Vehicles not used for one of the qualifying reasons above must be registered with State license plates

ATTENTION:

that display the agency name. If the primary use of the vehicle listed above changes and no longer qualifies for

exemption, the vehicle must immediately be re-registered with State plates.

CERTIFICATION

I certify that the above-described vehicle(s) is (are) registered or controlled by the state agency to which this

application for registration applies, and that the information contained herein is true and accurate. I do so in my

capacity as the

of the above-named state agency.

Commissioner or agency head

I understand that knowingly making a false statement on an application submitted to the Commissioner of Motor

Vehicles is a misdemeanor under Vehicle and Traffic Law, a misdemeanor or felony under New York State Penal Law,

and may result in criminal prosecution in addition to revocation or suspension of the registration pursuant to regulations

promulgated by the Commissioner of Motor Vehicles.

Signature

Date

Title

Print Name

(

)

Business Phone Number

Business E-Mail Address

DMV USE ONLY

Code from List

Code from IOCU

DMV Supervisor Approval

PAGE 2 OF 2

MV-82STA (11/17)

Form Mv-82sta - State Vehicle Registration/title Application Page 2