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Fillable Printable Alpha Kappa Alpha

Fillable Printable Alpha Kappa Alpha

Alpha Kappa Alpha

Alpha Kappa Alpha

MVR-27KA
(Revised9/17)
North Carolina Division ofMot or Ve
hicles
3155Mail Service Center
Raleigh, NC27697-3155
APPLICATION FOR AN
ALPH A KAPPA ALPH A
LICENS E P
LATE
Remit a $10.00/$40.00 check or money order with this application.
First in Flight Background
First in Freedom Background
Regular Alpha Kappa Alpha$10.00
Personalized Alpha Kappa Alpha$40.00
NOTE: You are allowed four (4) spaces for a personalized message.
___ ___ ___ ___
When applying for a Personalized Alpha Kappa Alphalicense plate, the suffix KAwill be the lastletters on the plate. This leaves only
four (4) spaces for a Personalized message. The four spaces may be a combination of letters and numbers, but cannot be numbers only.
Choice cannot conflict with a nother class of license plates.
The $10.00/$40.00 special fee is an ( ANNUAL) fee due in addition to the regular license fee.
Home
_______________________
AR EA CODE-TE LE PHON E N U MBER
Office
______________________
AR EA CODE-TE LE PHON E N U MBER
NAME(To agree with certificate of title)
____________
____________________________________________________
FIRST MIDDLE LAST
________________________________________________________________
ADDRESS
________________________________________________________________
CITY STATE ZIP CODE
Current North Carolina
__________________
Plate Number
_________________
Driver License #
_________________________________________
Vehicle Identifica tion Number
____________
_____________________________
Year Model Make Body Style
Owner’s Certifica tion of Liability Insura nce
I CERTIFY FOR THE M OTOR VEHICLE DESCRIBED ABOVE THAT I HAVE FINANCIAL RESPONSIBILITY AS RE QUIRED BY LAW.
______
_______________________________________________________________________________________________________________________________
PRINT OR TYPE FULL NAME OF INSURANCE COM PANY AUTHOR IZED IN N.C. NOT AGENCY OR GROUP
______
________________________________________________________________________________________________________________________________
POLICY NUMBER IF POLICY NOT ISSUED, N AME OF AGENCY BINDING COVER AGE
______
_____________ ________________________ _________ _____________________________________________
SIGNATURE OF OWNER DATE OF CERTIFICATION
K
A
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