Check our website for exact space allowances and configuration restrictions. You may provide up to three letter/number
combination choices. Use a period (.) on the line in the choice where you want the space. DMV reserves the right to reject,
recall or cancel any plate that is deemed objectionable. This includes plates that have already been issued.
Gold
Plates:
o Passenger o Commercial o Motorcycle
This form is used to apply for custom plates that cannot be ordered on our website. For a complete list of all of our plates, pricing
information, and eligibility requirements, please visit our website at dmv.ny.gov/nav/custom-plates.
IMPORTANT: Making a false statement in any registration application or in any proof of statements in connection with it, or
deceiving or substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law,
and may also result in the revocation or suspension of the registration and/or the applicant’s license pursuant to regulations
established by the Commissioner. The act of renewing these plates shall constitute your certification that you remain eligible to
continue holding these plates.
I WOULD LIKE TO APPLY FOR:
PAYMENT METHOD:
o Standard plates (number assigned by DMV)
o Personalized plates (Passenger Plates, Commercial Plates or Motorcycle Plates)
o Symbol of Access Requested (you must qualify). If the Symbol of Access is required, four or five spaces are allowed.
o Check o Money Order Make check or money order payable to “Commissioner of Motor Vehicles”.
Name (as it appears on credit card)
Credit Card Number
Expiration Date
Authorized Signature X
Please allow 4 to 6 weeks for delivery. If annual custom plate fees apply, they will be included in your registration renewal.
PLEASE PRINT INFORMATION BELOW
Last Name
Address (Include Street Number and Name and/or Rural Delivery Box No.)
check if new
Apt. #
Current Plate Number
Vehicle Model Year Vehicle Make
City State Zip Code
Signature (Sign Name in Full)
X
Plate
type:
Date
/ /
Daytime Phone (include area code)
( )
First M.I. Date of Birth (Month/Day/Year)
/ /
Which plate are you applying for? (Refer to the list with eligibility and fee information on our website dmv.ny.gov/nav/custom-plates.)
Doyourcurrent plates have
the Symbol of Access?
If you need the Symbol of Access on your new plates and you do not have it on your current plates,
you must also submit a completed form MV-664.1, which may be printed from the DMV website.
APPLICATION FOR CUSTOM PLATES
Credit Card: o American Express o Discover o Master Card o Visa
oYes oNo
Picture
Plates:
1st 2nd
3rd
SecurityCode
3 or 4 digit code on the
back or front of your card
1st 2nd 3rd
CLEAR
CP-30 (1/19)
Return this completed form, the required proof if needed, and payment to:
Department of Motor Vehicles, Custom Plates Unit, PO Box 2775, Albany, NY 12220-0775
Custom Plates Unit (518) 402-4838:
M-F 8:00am - 4:00pm
Become an Organ Donor! Visit donatelife.ny.gov
