Form Mv-904so - Application For Special Organization Registration Plate - Department Of Transportation

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MV-904SO (7-17)
APPLICATION FOR SPECIAL
www dmv pa gov
ORGANIZATION REGISTRATION PLATE
For Department Use Only
Bureau of Motor Vehicles • P.O. Box 68266 • Harrisburg, PA 17106-8266
Check One: Leased Vehicle:
YES
NO
NOTE: If the vehicle is a leased vehicle, Form MV-1L, “Application for Lessee Information,” must be completed and attached. Form MV-1L is available on our
website at
A
VEHICLE DESCRIPTION AND APPLICANT INFORMATION -
Complete this section exactly as information appears on current registration card.
Title Number
Registration Plate Number
expiration Date
Make of Vehicle
Year
Last Name (Or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
or Bus. ID#
Street Address - Must list a street address. P.O. Box # alone is not acceptable.
City
State
Zip Code
Telephone Number
Home (
) ___________________
Work (
) ___________________
NOTE: In conjunction with replacement of your registration plate, you will receive one registration card. If additional registration cards are desired, the fee is
$2 for each card. Number of Duplicate Registration Cards Requested @ $2 each _________.
B
TO BE COMPLETED BY ORGANIZATION OFFICIAL
NAME OF ORGANIZATION
American Legion, Department of Pennsylvania (A2)
Name of Organization, Chapter, Post, Lodge, employer, etc.
Telephone Number
Street Address
City
State
Zip Code
C
TO BE COMPLETED BY ORGANIZATION OFFICIAL
(See special instructions below.)
I certify that the individual named in Section A is a member in good standing of the organization listed in Section B.
________________________________________ ________________________________ _________________________________________________
Name of Organization Official
Title
Signature
D
APPLICANT SIGNATURE
I certify that all information given on this application is TRUe AND CORReCT and that when I cease to be a member of the above named organization, I will
immediately return the registration plate to PennDOT.
_______________________________________________________________________________________
_________________________________
Applicant’s Signature in Ink
Date
GENERAL INFORMATION REGARDING A SPECIAL ORGANIZATION PLATE
• PennDOT charges an issuance fee of $26. Participating organizations may charge an additional fee above the $26 PennDOT fee. The organization fee is
$________________. Therefore, the total fee due with this application is $________________. Fees must be made payable to the organization name of
______________________________________________________________________________________________________________________________.
• Payment is to be made by check or money order payable to Commonwealth of Pennsylvania. DO NOT SEND CASH. NO REFUND of the fee will be issued
when an applicant cancels a request after an order is placed.
• No special organization registration plate will be duplicated. If your plate is lost, stolen or defaced you will need to reapply for a special organization registration
plate by completing this application and submitting with the appropriate fees. Should you need an immediate replacement registration plate, please complete
and submit Form MV-44, “Application for Duplicate Registration Card, Replacement of Registration Plate or Weight Class Sticker," with a fee of $11. A standard
issued registration plate will be issued until the replacement special organization registration plate can be provided. (NOTE: Form MV-44 is available on our
website at )
• Requests for special organization registration plates are restricted to passenger vehicles, trucks with a registered gross weight of not more than 14,000 lbs.,
motor homes, and trailers. Motorcycles do not qualify for special organization registration plates.
• This application, completed in full, along with a check or money order should be mailed to: Bureau of Motor Vehicles, Special Organization Plate Program,
P.O. Box 68266, Harrisburg, PA 17106-8266.
• When the applicant ceases to be a member in the organization or ceases to be a notary public as listed in Section B, the registration plate must be returned to
PennDOT. Complete Form MV-44 and submit a fee of $11 for the issuance of a regular series registration plate.
• This special organization registration plate is issued in number sequence only and may not be personalized.
• All telephone numbers will be held in confidence and used only in the event of a problem with your application.
• To avoid possible problems with citations with your old registration plate, return it to: Bureau of Motor Vehicles, Return Tag Unit, P.O. Box 68597, Harrisburg, PA
17106-8597 after you have received your special organization registration plate.
SPECIAL INSTRUCTIONS - SECTION C
• If the applicant is a notary applying for a notary public registration plate, the applicant’s notary seal must be affixed in this section instead of an official’s signature.-
Visit us at or call us at:
In state: 1-800-932-4600 - TDD: 1-800-228-0676 - Out-of-State: 1-717-412-5300 - TDD Out-of-State: 1-717-412-5380

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