Sixth Choice
Fifth Choice
Fourth Choice
Description of what the configuration
above stands for.
Third Choice
First Choice
Form
1716
Application for Missouri Personalized
and Special License Plates
Owner’s Name
Street, RR, or P.O. Box Number
City State ZIP Code
Daytime Phone Number Current Plate Number
Name must appear as shown on vehicle title
__ __ __ __ __ __
(Please check which category of license plate you need)
(__ __ __)__ __ __-__ __ __ __
Step 1
Any false statement in this application is a violation of the law and may be punished by fine or imprisonment or both.
Step 2
For all plates listed as “Stock,” the Missouri Department of Revenue will select your license plate configuration.
Submit fee shown below with this application.
r Regular Personalized ($15)
(Can be reserved at plates.mo.gov)
r Amateur Radio ($15)
r American Heart Association ($15)
r American Legion ($15)
r Back the Blue ($15)
r Be An Organ Donor ($15)
r Breast Cancer Awareness ($15)
r Cave State ($15)
r Children’s Trust Fund (Stock) ($15)
r Children’s Trust Fund ($15)
r Choose Life ($15)
r Collegiate ($15)
Name of College or University ________________
r Coroner’s Office ($15)
r Custom Vehicle ($15)
r Disabled Person ($15)
r Don’t Tread on Me ($15)
r Ducks Unlimited ($15)
r Eagle Scout ($15)
r Eastern Star - Harmony Chapter ($15)
r Emergency Medical Technician ($15)
r Fight Terrorism ($15)
r Firefighter (Stock) ($15)
r Firefighter ($15)
r Former Legislator ($15)
Last Year Served ________________________
r Fraternal Order of Eagles ($15)
r Fraternal Order of Police ($15)
r Friends of Arrow Rock ($15)
r God Bless America ($15)
r Greek Collegiate Organization ($15)
______________________________________
r Hearing Impaired Kids Endowment Fund ($15)
r Helping Schools ($15)
r I’m Pet Friendly ($15)
r Jefferson National Parks Association ($15)
r Kingdom of Calontir ($15)
r Knights of Columbus ($15)
r Lions Club (Stock) ($15)
r Lions Club ($15)
r Masonic Grand Lodge ($15)
r Masters ($15)
r Missouri 4-H ($15)
r Missouri Association of Realtors ($15)
r Missouri Bicycle & Pedestrian Federation ($15)
r Missouri Botanical Garden ($15)
r Missouri Conservation Heritage (Stock) ($15)
r Bird r Deer r Bald Eagle
r Missouri Conservation Heritage ($15)
r Bird r Deer r Bald Eagle
r Missouri Elks Association ($15)
r Missouri Federation of Square & Round
Dance Clubs ($15)
r Missouri Jaycee (Stock) ($15)
r Missouri Jaycee ($15)
r Missouri Junior Golf Foundation ($15)
r Missouri Nurses Foundation ($15)
r Missouri Remembers POW/MIA ($15)
r Missouri Stream Team Coalition ($15)
r Missouri Task Force 1 ($15)
r Missouri Travel Council ($15)
r MKN Conference of Teamsters ($15)
r MO-AG Businesses ($15)
r Order of the Arrow ($15)
r Paramedic ($15)
r Prince Hall ($15)
r Professional Sports Team ($15)
r St. Louis Blues r St. Louis Cardinals
r Kansas City Chiefs r Kansas City Royals
r Rotary International ($15)
r Safari Club International ($15)
r Search and Rescue ($15)
r Shriners ($15)
r Special Olympics ($15)
r Street Rod ($15)
r Tribe of Mic-O-Say ($15)
r Kansas City District r St. Joseph District
r Wilson Creek Battlefield ($15)
r Zoos ($15) r Kansas City r St. Louis
r Shuttle Bus ($15) — regular personalized
r Vanpool ($15) — regular personalized
r Other ________________________________
Note: Please contact the Missouri Department
of Revenue for other specialty plates
that may be available.
Please use all capital letters and show choices in order of preference. Regular personalized license plates may consist of no more than six characters plus a dash, a space, or an
apostrophe. Personalized plates displaying an emblem or wheelchair symbol may consist of no more than six characters or five characters plus a dash, a space, or an apostrophe.
Personalized plates displaying an emblem and wheelchair symbol are limited to four characters or three characters plus a dash, a space, or an apostrophe. Personalized cycle
plates may consist of no more than six characters or five characters plus a dash, space, or an apostrophe. Personalized cycle plates displaying an emblem or wheelchair
symbol may consist of no more than five characters or four characters plus a dash, space, or an apostrophe. Personalized cycle plates displaying an emblem and wheelchair symbol
may consist of no more than three characters or two characters plus a dash, space, or an apostrophe. The Missouri Department of
Revenue will not issue plates that contain any letters,
numbers, or a combination of letters and numbers which are obscene, profane, patently offensive or contemptuous of a racial or ethnic group, offensive to good taste or decency, or
would present an unreasonable danger to the health or safety of the applicant, of other users of streets and highways, or of the public in any location where the vehicle with such plate
may be found. The Missouri Department of Revenue will not issue plates that conflict with the regular license numbering system.
Step 3
Personalized plate choices (complete only if applying for personalized plates. Please include more than one choice.)
Year Make Model VIN Number
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Description of what the configuration
above stands for.
Description of what the configuration
above stands for.
Description of what the configuration
above stands for.
Description of what the configuration
above stands for.
Second Choice
Description of what the configuration
above stands for.
Vehicle Plate Will
Be Attached To
Office Office Number
Street City
Signature of Owner
or Applicant
I hereby certify under penalty of perjury that all information regarding this request is true and accurate and
is made without intent to defraud and that all statutory requirements for personalized or special license
plates have been met. I also acknowledge that, if the requested configuration is already issued for a
vehicle I own, I must surrender those plates when I pick up the new plates bearing that configuration.
__ __ __
X
Step 4
Must be completed by all applicants. These license plates will not be mailed. Indicate name of license office where plates are to be picked up.
Form 1716 (Revised 10-2019)
r Passenger r Recreational Vehicle (motor home)
r Beyond Local 6 Truck r Local 6 Truck (limited to a 50 mile radius)
r Beyond Local 12 Truck r Local 12 Truck (limited to a 50 mile radius)
r Beyond Local 18 Truck r Local 18 Truck (limited to a 50 mile radius)
r Beyond Local 24 Truck r Local 24 Truck (limited to a 50 mile radius)
r Motorcycle r Motortricycle r Autocycle
r Check here to add this symbol to your plate. (Form 1776, Physician’s
Statement for Disabled Person’s License Plates is required. See back
for more information.)