Fillable TEMPORARY LICENSE PLATE APPLICATION 30-90 Day Operating Permit (Wisconsin)

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TEMPORARY LICENSE PLATE APPLICATION 30-90 Day Operating Permit (Wisconsin)

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TEMPORARY LICENSE
PLATE APPLICATION
30-90 Day Operating Permit
Wisconsin Department of Transportation
MV2505 6/2018 s.341.09 Wis. Stats.
Complete form using BLUE or BLACK ink.
Make Check Payable To: Registration Fee Trust
Mail To: Wisconsin Department of Transportation
Special Plates
P.O. Box 7911
Madison, WI 53707-7911
Temporary license plates may be received
immediately at any DMV service Center
which provides registration services.
A $5 counter service fee will apply unless
issuance is due to mandatory display.
License Plate Number
1
2
4
5
6
7
8
Vehicle Identification Number (standard VIN has 17 characters)
1
3
4
5
6
7
8
9
10
11
12
14
15
16
17
Vehicle Year
Make
Print Registration Owner’s Name – Last, First, MI
Owner Lessee Driver
Birth Date
–
–
M
M
D
D
Y
Y
Y
Y
Street Address
City
State
ZIP Code
Social Security Number (optional)
–
–
1
2
4
5
6
7
8
9
Mailing Address (if different form above)
(Area Code) Telephone Number Between 7:30 a.m. and 4 p.m.
I request a temporary plate for the vehicle listed above because:
(I)
The vehicle failed the emission test and is being repaired ($3 for 30 days)
(O)
The vehicle was purchased in WI and is being driven home to: ($3 for 30 days)
(L)
I am an active duty military personnel home on leave (Free for 30 days)
Requested Operation Dates (m/d/yy)
(V)
Collector or Hobbyist for January operation ($5 for 5 days) . . . . . . . . . . . .
Begin: End:
Vehicle Currently Registered and Used for Regular Transportation
Maximum of 5 days
Vehicle Identification Number (standard VIN has 17 characters)
1
2
3
4
5
6
7
8
9
11
12
13
14
15
16
17
Vehicle Year
Make
(T)
Other (Not Mandatory Display) ($3 for 90 days) Explain:
(X)
Other (Mandatory Display) (Free for 90 days)
X
(Registration Owner’s Signature) (Date)
UNDER 18
YEARS OLD
I certify that I have legal custody of the person named as
Registration Owner and consent to the registration of the vehicle
described in the applicant’s name.
Date Signed
Signature (legal custodian, parent or guardian)
X
NOTARY
PUBLIC
County
Date my commission expires
Date subscribed and sworn to before me
Notary Signature
X
Release of non exempt information
Under Wisconsin open records law, the Wisconsin Department of
Transportation must provide information from its records to requesters.
If you do not want your name and address included in requests we
receive for ten or more records, you may ask the department to
withhold your name and address from those lists by checking the box
below:
Opt Out
ADA - The Wisconsin Department of Transportation complies with the
Americans with Disabilities Act.
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TEMPORARY LICENSE PLATE APPLICATION 30-90 Day Operating Permit (Wisconsin)

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Completed 11 May 2021

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