Fillable APPLICATION FOR PERSONALI Z ED LICENSE PLATE (Florida)

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APPLICATION FOR PERSONALI Z ED LICENSE PLATE (Florida)

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The APPLICATION FOR PERSONALI Z ED LICENSE PLATE (Florida) form is 1 page long and contains:

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Country of origin: US
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Centered Graphic
Left Graphic
(7 characters, may also have an additional space or hyphen.
(5 characters)
STATE OF FLORIDA
DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES – DIVISION OF MOTORIST SERVICES
SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OR LICENSE PLATE AGENT OFFICE
www.flhsmv.gov/locations/
APPLICATION FOR PERSONALI Z ED LICENSE PLATE
INSTRUCTIONS ARE INDICATED ON REVERSE SIDE Date of Application
PLEASE CONTACT YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE, LICENSE PLATE AGENT
OR REFER TO THE REVERSE SIDE OF THIS FORM FOR FEE INFORMATION.
OWNER / APPLICANT IDENTIFICATION
Owner’s / Lessee’s Name:
Sex:
Date of Birth:
Street Address:
City:
State:
Zip:
Owner’s / Lessee’s D/L Number:
Owner’s / Lessee’s E-mail Address:
FEID#:
Co-Owner’s / Co-Lessee’s Name:
Sex:
Date of Birth:
Street Address:
City:
State:
Zip:
Co-Owner’s / Co-Lessee’s D/L Number:
Co-Owner’s / Co-Lessee’s E-mail Address:
FEID#:
VEHICLE INFORMATION
Current Decal Number:
Current License Plate Number:
Vehicle Type:
Title Number:
Vehicle Identification Number:
Vehicle Make:
Year:
Color:
Vehicle Weight:
CERTIFICATION
This is to certify that I am/we are the registered owner/lessee or co-owner/co-lessee of the motor vehicle referenced above.
I/we authorize my/our name, address, and renewal date to be provided to the organization sponsoring the specialty license plate selected.
Under penalties of perjury, I/we declare that I/we have read the foregoing document and that the facts stated in it are true.
Signature(s):
LICENSE PLATE SELECTION (see reverse side for plate choices)
Enter the type of license plate requested: (see reverse
side of this form for types of plates and fees)
Specify the intended meaning/explanation for your
personalized license plate configuration choice
(nickname, initials, etc.):
Please Note:
•
Use no more than the number of characters authorized for the type of license plate you have requested
(including a space or hyphen, see reverse side).
•
For license plates with center graphic, allow two spaces for the logo or characters will cover the graphic design.
A regular motorcycle may have a Florida graphic.)
1ST CHOICE
2ND CHOICE
3RD CHOICE
4TH CHOICE
INSTRUCTIONS
1. Carefully read all information on the front and back of this application before completing the application.
2. Complete the application form and submit it to your local county tax collector's office or license plate agent with the following items:
a. PROOF OF FLORIDA INSURANCE: Proof of personal injury protection (PIP) and property damage liability insurance (PDL) must be submitted in the form
of a card, policy, binder, certificate of insurance or affidavit.
b. A copy of your current registration certificate or renewal notice.
c. Remittance fees (payable to your county tax collector/license plate agent).
3. Please allow six to eight weeks for the manufacture and delivery of the license plate. The license plate will be delivered to your county tax collector's office or
license plate agent.
HSMV 83043 (Rev. 05/19) S www.flhsmv.gov
IMPORTANT INFORM ATION ABOUT YOUR CHOICE
You may check personalized plate availability at the department’s website located at https://services.flhsmv.gov/MVCheckPersonalPlate/
Your local county tax collector's office or license plate agent may assist you in determining if a specific type of license plate is available, as well
as the choice for personalization and the total cost of the license plate you desire, including trucks (with a net weight of more than 5,000 pounds),
"for-hire" vehicles and trailers.
•
Your choice may include letters, numbers, a space or a hyphen as characters.
License plates that have 7 characters may have an
additional space or hyphen. However, license plates that have 5 characters, may NOT have an additional space or hyphen.
•
Requests with obscene or objectionable words will be rejected. If a personalized license plate has been issued and later determined to be
obscene or objectionable, the department will recall the license plate.
TYPE OF LICENSE PLATES
Personalized license plates for motorcycles are only available as a "Florida Graphic" or "Motorcycle Specialty" license plate.
A mount Includes A ll Fees (SEE "FEE EXCEPTIONS" BELOW).
TYPES OF LICENSE PLATES
(See https://www.flhsmv.gov/dmv/specialtytags/ for more information)
MAXIMUM
CHARACTERS
FEES
AIR FORCE ** ARMY ** COAST GUARD **
INDIAN RIVER LAGOON ** MARINE CORPS ** NAVY **
OLYMPIC SPIRIT ** SALUTES VETERANS ** SHARE THE ROAD **
TAMPA BAY ESTUARY **
5
$71.40
CHOOSE LIFE ** EVERGLADES RIVER OF GRASS ** SALUTES FIREFIGHTERS **
SUPPORT LAW ENFORCEMENT ** POLICE ATHLETIC LEAGUE ** PROTECT WILD DOLPHINS **
SUPPORT EDUCATION *
5
$76.40
FISH FLORIDA**
5
$78.40
A STATE OF VISION ** AGRICULTURE EDUCATION **
ANIMAL FRIEND ** PROTECT OUR OCEANS
CHALLENGER/COLUMBIA **
CONSERVE WILDLIFE ** DISCOVER FLORIDA HORSES
DISCOVER FLORIDA OCEANS **
DONATE ORGANS ** END BREAST CANCER **
ENDLESS SUMMER
FLORIDA HORSE PARK FLORIDASHERIFF'S YOUTH RANCHES FRATERNALORDER OF POLICE
FREEMASONRY ** GO FISHING ** HORSE COUNTRY **
HOSPICE EVERYDAY IS A GIFT ** IN GOD WE TRUST ** KEEP KIDS DRUG FREE **
KIDS DESERVE JUSTICE ** NASCAR ** PARENTS MAKE A DIFFERENCE **
PLAY TENNIS ** PROTECT FLORIDA WHALES ** PROTECT OUR REEFS **
(***) SAVE OUR SEAS ** SAVE WILD FLORIDA WILDLIFE FOUNDATION OF FLORIDA *
STOP CHILD ABUSE ** SUPPORT AUTISM PROGRAMS ** TREES ARE COOL **
SUPPORT HOMEOWNERSHIP FOR ALL** SUPPORT OUR TROOPS ** VISIT OUR LIGHTS **
LAUREN’S KIDS ** BIG BROTHERS BIG SISTERS ** FALLEN LAW ENFORCEMENT OFFICERS**
FLORIDA SHERRIFFS ASSOCIATION **
5
$81.40
MOTORCYCLE SPECIALTY **
6
$73.40
FLORIDA GRAPHIC * FLORIDA STATE MOTTO *
7
$51.40
SPECIAL OLYMPICS FLORIDA * STATE W ILDFLOW ER *
7
$71.40
AGRICULTURE * INVEST IN CHILDREN *
SCOUTING TEACHES VALUES * STATE OF THE ARTS *
7
$76.40
HELPING SEA TURTLES SURVIVE *
7
$79.40
(***)AQUACULTURE * FAMILY FIRST * FAMILY VALUES *
GOLF CAPITAL OF THE WORLD * IMAGINE* LIVETHEDREAM*
PROTECT THE PANTHER * PROTECT FLORIDA SPRINGS
*SAVETHEMANATEE*
STOP HEART DISEASE* UNITED WE STAND *
7
$81.40
COLLEGIATE:
BARRY UNIVERSITY ** BETHUNE-COOKMAN UNIVERSITY **
CLEARWATER CHRISTIAN COLLEGE ** EDWARD WATERS COLLEGE **
EMBRY-RIDDLE AERONAUTICAL UNIVERSITY ** FLAGLER COLLEGE **
FLORIDA A & M UNIVERSITY ** FLORIDA ATLANTIC UNIVERSITY **
FLORIDA COLLEGE ** FLORIDA GULF COAST UNIVERSITY ** FLORIDA
INSTITUTE OF TECHNOLOGY ** FLORIDA INTERNATIONAL UNIVERSITY **
FLORIDA MEMORIAL UNIVERSITY ** FLORIDA SOUTHERN COLLEGE **
FLORIDA STATE UNIVERSITY ** JACKSONVILLE UNIVERSITY **
LYNN UNIVERSITY ** NEW COLLEGE OF FLORIDA **
NOVA SOUTHEASTERN UNIVERSITY ** PALM BEACH ATLANTIC UNIVERSITY **
RINGLING SCHOOL OF ART AND DESIGN * * ROLLINS COLLEGE **
SAINT LEO UNIVERSITY ** SAINT THOMAS UNIVERSITY **
SOUTHEASTERN UNIVERSITY ** STETSON UNIVERSITY **
UNIVERSITY OF CENTRAL FLORIDA ** UNIVERSITY OF FLORIDA **
UNIVERSITY OF MIAMI ** UNIVERSITY OF NORTH FLORIDA **
UNIVERSITY OF SOUTH FLORIDA ** UNIVERSITY OF TAMPA **
UNIVERSITY OF WEST FLORIDA ** WARNER SOUTHERN COLLEGE **
KEISER UNIVERSITY **
5
$81.40
ECKERD COLLEGE* FLORIDA HOSPITAL COLLEGE OF HEALTH SCIENCES*
7
$81.40
FLORIDA PROFESSIONAL SPORTS TEAM:
FLORIDA MARLINS ** FLORIDA PANTHERS ** JACKSONVILLE JAGUARS **
MIAMI DOLPHINS ** MIAMI HEAT ** ORLANDO MAGIC **
TAMPA BAY BUCCANEERS ** TAMPA BAY LIGHTNING ** TAMPA BAY RAYS **
5
$81.40
* G r ap hi c d e si gn i s ce n te re d o n th e p l at e.
* * G r ap hic d e si g n i s o n th e f a r l ef t /r i g h t si d e o f t h e p l at e.
* * * I f ap p l y i n g f o r m o r e th a n 10 li cen s e p l a te s f o r th e s am e ow n e r, th e f e e i s $ 67.55 p e r li c en s e p l at e.
FEE EXCEPTIONS: An additional branch fee of $.50 may be required by some county agencies.
An additional license plate mail fee of $4.70 is required if a license plate is mailed to the applicant.
The annual or biennial registration fee is due in addition to these fees shown.
Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/locations/
HSMV 83043 (Rev. 05/19) S www.flhsm v.gov
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APPLICATION FOR PERSONALI Z ED LICENSE PLATE (Florida)

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Completed 15 October 2020

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