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Fillable Printable Application For A Collegiate Insignia License Plate

Fillable Printable Application For A Collegiate Insignia License Plate

Application For A Collegiate Insignia License Plate

Application For A Collegiate Insignia License Plate

MVR-27C
(Revised 9/2017)
North Carolina Di
vision of Motor Vehicles
3155 Mail Service Center
Raleigh, NC 27697-3155
APPLICATION FOR A CO L LE G IAT E INSIGNI A LICENSE PLATE
Remit a $25.00/$55.00 check or money order with this application.
COLL
EGE NAME _____________________________________________
First in Flight Background
First in Freedom Background
Regular Collegiate $25.00
Personalized Collegiate $55.00
NOTE: You are allowed four (4) spaces for a personalized message. ___ ___ ___ ____
When applying for a Personalized Collegiate license plate, the prefix/suffix will be the first/last letters 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 another cla ss of license plate s.
The $25.00/$55.00 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-TELEPHONE 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
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