Application For A Marine Corps League License Plate printable pdf download

APPLICATION FOR A

MARINE CORPS LEAGUE

LICENSE PLATE

Remit a $10.00/$40.00 check or money order with this application

made payable to: NC DMV or North Carolina Dept. of Motor Vehicles.

Mailing address is: Supervisor, Vehicle Services Special Plate Unit

3155 Mail Service Center

Raleigh NC 27699-3155

***Please Print Legibly***

Regular Marine Corps League $10.00

Personalized Marine Corps League $40.00

NOTE: You are allowed four (4) spaces for a personalized message.

___ ___ ___ ____

When applying for a Personalized Marine Corps League license plate, the prefix/suffix will be the first/last letters on the plate. This

leaves only four (4) spaces for a Personalized message. The four spaces may be a combination of letters and numbers, but cannot be

numbers only. Choice cannot conflict with another class of license plates.

I hereby certify that I am member of the Marine Corps League____________________________________________.

(signature to agree with registration of the vehicle)

The $10.00/$40.00 special fee is an (ANNUAL) fee due in addition to the regular license fee.

NAME(To agree with certificate of title)

Home

________________________________________________________________

FIRST

MIDDLE

LAST

_______________________

AREA CODE-TELEPHONE NUMBER

________________________________________________________________

ADDRESS

Office

______________________

________________________________________________________________

AREA CODE-TELEPHONE NUMBER

CITY

STATE

ZIP CODE

Current North Carolina

Detachment #

_________________________________________

__________________

Vehicle Identification Number

Plate Number

______________________

_________________

_________________________________________

Driver 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

Application For A Marine Corps League License Plate

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