Friends North Carolina Maritime Museum License Plate Application printable pdf download

Friends North Carolina Maritime Museum License Plate Application

APPLICATION FOR A NORTH CAROLINA MARITIME MUSEUM LICENSE PLATE

Please remit $30 check or money order (to NC DMV) and send with this application to:

Friends of the Museum, 315 Front St., Beaufort, NC 28516

The $30.00 special fee is an ANNUAL fee due in addition to the regular license fee. The Friends of the

Museum will receive $20 annually for each plate purchased. Thank you for your support!

See other side for more information.

NAME (To agree with certificate of title):

HOME:

FIRST

MIDDLE

LAST

AREA CODE-PHONE NO.

ADDRESS

OFFICE:

CITY

STATE

ZIP CODE

AREA CODE-PHONE NO.

CURRENT NC:

_________________________________________

__________________

VEHICLE IDENTIFICATION NUMBER

E-MAIL:

PLATE NUMBER

___________________

__________________________________________

DRIVERS LICENSE #

YEAR MODEL

MAKE

BODY STYLE

Owner’s Certification of Liability Insurance

I CERTIFY FOR THE MOTOR VEHICLE DESCRIBED ABOVE THAT I HAVE FINANCIAL RESPONSIBILITY AS REQUIRED BY LAW.

____________________________________________________________________________________________________________

PRINT OR TYPE FULL NAME OF INSURANCE COMPANY AUTHORIZED IN N.C. - NOT AGENCY OR GROUP

____________________________________________________________________________________________________________

POLICY NUMBER - IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE

________________________________

_______________________________

SIGNATURE OF OWNER

DATE OF CERTIFICATION

(Find this application on the web at: )

Friends North Carolina Maritime Museum License Plate Application