Form Mv-Rl - Request For Manufacture Of A Legislator Emeritus License Plate
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1Form MV-RL (Rev. 08-2013)
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Georgia Department of Revenue - Motor Vehicle Division
Request for Manufacture of a Legislator Emeritus License Plate
_______________________________________________________________________________
Purpose of this Form: This form is to be used to apply for a Legislator Emeritus License Plate/tag. This
form should not be used to record a change of ownership, change of address, or change of license plate
classification.
Qualification: This plate is only available to members of the General Assembly and former members of the
General Assembly who are hereby deemed to have emeritus status after having served in the General
Assembly for eight or more years.
Required documentation: Legible copy of the Certification from their local board of elections, Resolution
from the Georgia House or Senate, verification from documentation published by the General Assembly
(such as composites or information from past sessions which have been posted).
Required Fees: $25 manufacturing fee (one time fee), $35 annual special tag fee, $20 standard tag fee,
plus ad valorem tax (if applicable).
OWNER INFORMATION:
First Name
Middle Initial
Last Name
Suffix
Owners’ Full Legal Name:
Mailing Address
(
)
State
Zip
Telephone #
City
First Name
Middle Initial
Last Name
Suffix
Owner(s)’ Full Legal Name(s):
(If Secondary Owner(s) are listed)
Mailing Address
Zip
City
State
Telephone #
(
)
VEHICLE INFORMATION:
Model:
Year:
Make:
Vehicle Identification Number (VIN):
CERTIFICATION
O.C.G.A. § 40-2-3. “Any person who shall make any false statement in any application for the registration of any
vehicle, or in transferring any certificate of registration, or in applying for a new certificate of registration, shall be
guilty of false swearing, whether or not an oath is actually administered to him, if such statement shall purport to be
under oath. On conviction of such offense, such person shall be punished as provided by Code Section 16-10-71.”
State of Georgia
_____/_____/_____
Driver’s License #
_______________________
Date
Signature
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