Section 5. Required Documents Faxed to Motor Vehicles Division
Do NOT submit with your certification.
The following documents must be submitted by FAX ATTN: Specialty Plates to 406.444.2086
Proof of Montana banking institute.
page of most recent bank statement showing sponsor name, address, date, banking institution’s
name, and account number.
REDACT all financial information from this page, including balances, debits and credits.
• I understand and accept MCA 61-3-472 through 61-3-481 Specialty License Plate requirements.
• I have reviewed my organization's information as listed on the Motor Vehicle Division's website
https://dojmt.gov/driving/plate-designs-and-fees/ and no updates are needed at this time. If
updates are needed, submit form MV120.
• Under penalty of law (MCA 45-7-203), I certify that the statements
made and information contained
on this form, the attached form, and banking statements are true and correct to the best of my
knowledge, information, and belief; I am the person named on this form; and, if signing for a business
entity or trust, I have full authority to do so.
For office use only
The annual certification for sponsorship is approved.
MVD Coordinator Signature/Date
The annual certification for sponsorship
is rejected for the following reason:
Section 6. Indemnification Section:
Section 7. Certification Section:
The Sponsor agrees to indemnify, hold harmless, and release DOJ/MVD and their officers, agents
and employees from and against all loss, damages, injury, liability, suits and proceedings arising
from the use of the name, identifying phrase, and graphic on the generic specialty license plate,
including but not limited to any loss, damages, injury, liability, suits or proceedings from the use of
the name, Identifying phrase, and graphic.