Motor Vehicle Administration
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov
Application/Certication for Organizational License Plates
VR-124 (11-12)
Instructions: Please complete the entire application (owner and/or co-owner). Submit appropriate fees with application.
Name of Organization:
I certify that the individual below is a bona de member of the above organization:
Signature of Authorized Representative
Owner’s Name, First Middle Last Driver’s License Number
Street Address City County State Zip Code
Co-Owner’s Name, First Middle Last Driver’s License Number
I hereby authorize the representative of my organization to review/release my personal information for ofcial purposes:
Owner’s Signature Co-Owner’s Signature
Vehicle Information
Year Make Sticker No. Title No. Tag No.
Vehicle Identication Number
Insurance Co. Policy/Binder No.
Organizational Member: (Check one) ❑ Owner ❑ Co-Owner
Check Class: ❑ Passenger Car ❑ Multi-purpose vehicle ❑ Truck 1 ton or less ❑ Motorcycle
Fees: Non Logo Organizational Tags: $15.00 Logo: $25.00
I certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge:
Signature of Owner Date
Signature of Co-Owner Date
MVA Use Only: ❑ New Issue ❑ Substitute ❑ Surviving Spouse ❑ S/N
❑ Gratis ❑ Paid Approved by: Tag Issued:
You may either mail your application and the appropriate fees to:
Motor Vehicle Administration, Vehicle Registration Organizational Unit; 6601 Ritchie Highway, Glen Burnie, MD 21062;
or visit the MVA full Service Ofce in Glen Burnie and have your plates issued to you.
Original - MVA Copy - Customer
Diana L. Chavis, City Clerk
Would you like to participate in the annual OC License Plate Parade on the Boardwalk? Allow us to pass your information along to the
Downtown Association by signing below.
.
I hereby authorize the representative of my organization to review/release my personal information to the Downtown Association of Ocean
City for the sole purpose of inviting you to the parade every year.
.
EMAIL ADDRESS: __________________________________ AND/OR PHONE NUMBER_____________________________________
.
Owner________________________________________ Co-owner______________________________________
.OR contact the Downtown Association of Ocean City, Maryland @ 410-289-1413
or contact Nancy (cell) 443-235-4405 (email) neffiehoward@comcast.net.
