DSD 9 (07/01/2015)
DMV USE ONLY
PLATE NUMBERS
DRIVE-AWAY/OFFICE TRAILER
PLATE APPLICATION
DRIVE-AWAY PLATES
If application is for drive-away plates, you must provide the following with your application:
1) Copy of your business license. If a business license cannot be provided, a letter from that jurisdiction will be required.
2) Copy of your insurance showing the number of Drive-Away Plates insured under that policy.
EXPLAIN WHAT THE DRIVE-AWAY PLATES WILL BE USED FOR
INSURANCE CERTIFICATION (check one box)
I/we certify that vehicles owned or assigned to my firm are insured by a policy issued through an insurance company licensed to do
business in Virginia and that the policy provides at least the minimum amount of coverage as required by Virginia law.
A certificate of self-insurance number ________________________________ has been issued by DMV pursuant to §46.2-368 for the
series of dealer's license plates issued.
NOTE: AUTOMOBILE LIABILITY INSURANCE MUST BE MAINTAINED ON EACH DRIVE-AWAY AND OFFICE TRAILER PLATE FOR AS LONG AS THAT
PLATE REMAINS VALID. Insurance certification is not required for office trailer plates.
CERTIFICATION
I certify and affirm that all information presented in this form is true and correct, that any documents I have presented to DMV are genuine, and that the
information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty of perjury and I understand that
knowingly making a false statement or representation on this form is a criminal violation.
OWNER, PARTNER OR OFFICER NAME (print)
OWNER, PARTNER OR OFFICER SIGNATURE
DATE (mm/dd/yyyy)
PRIVACY STATEMENT - In accordance with Virginia Code §§ 2.2-803, 2.2-4807 and § 58.1-520 et seq., the State Comptroller requires that this information,
including your social security number, be collected for debt set off collection purposes.
PLATE INFORMATION
DRIVE AWAY PLATES (check the box and enter number of plates requested) OFFICE TRAILER PLATES (check the box and enter number of plates requested)
Prorated Plate Fees (no refund on plates)
MONTHS DRIVE-AWAY OFFICE TRAILER
TOTAL MONTHS OF
REGISTRATION
FIRST 2 REGULAR
PLATES
EACH ADDITIONAL
PLATE
EACH REGULAR
PLATE
12 months 75.00 20.00 22.00
11 months 68.75 18.33 20.17
10 months 62.50 16.67 18.33
9 months 56.25 15.00 16.50
8 months 50.00 13.33 14.67
7 months 43.75 11.67 12.83
6 months 37.50 10.00 11.00
5 months 31.25 8.33 9.17
4 months 25.00 6.67 7.33
3 months 18.75 5.00 5.50
2 months 12.50 3.33 3.67
1 month 6.25 1.67 1.83
Reissue Plates and/or Decals
CHECK APPLICABLE BOX(ES) (Fees: $10.00 per plate - $1.00 per decal. No additional
fee at time of renewal.)
LOST DESTROYED
STOLEN MUTILATED
List the plate number below and check the box to indicate if the plate, decal
month or decal year is to be reissued.
Plate # Plate or Decal
Reissue
Plate
Reissue
Decal - Month
Reissue
Decal - Year
Reissue
Plate
Reissue
Decal - Month
Reissue
Decal - Year
Reissue
Plate
Reissue
Decal - Month
Reissue
Decal - Year
APPLICANT OR BUSINESS NAME OWNER NAME DMV CUSTOMER # / EMPL ID #
MAILING ADDRESS CITY STATE ZIP CODE
PHYSICAL ADDRESS CITY STATE ZIP CODE
WEBSITE ADDRESS EMAIL ADDRESS BUSINESS TELEPHONE NUMBER
