Fillable Printable Application For A Watermelon License Plate

Application For A Watermelon License Plate

MVR-27WM

(Revised 9/17)

North Ca

rolina Division of Motor Vehicles

3155 Mail Service Center

Raleigh, NC 27697-3155

APPLICATION FOR A WATERMELON LICE NSE PLATE

Remit a $10.00/$40.00 check or money order with this application.

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First in Flight Background

 First in Freedom Background

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Regular Watermelon $10.00

 Personalized Watermelon $40.00

NOTE: You are allowed four (4) spaces for a personalized message. ___ ___ ___ ____

When applying for a Personalized Watermelon license plate, the suffix WM will be the last letters on the plate. This leaves only four (4)

spaces for a Personalized message. T he four spaces may be a combination of letters and numbers, but cannot be numbers only. Choice

cannot conflic t with another cla ss o f license plates.

The $10.00/$40.00 special fee is an (ANNUAL) fee due in addition to the regular license fee.

Home

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AR EA CO DE-T ELEP HONE NUM BER

Office

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AR EA CO DE-T ELEP HONE NUM BER

NAME (To agree with certificate of title)

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FIRST MIDDLE LAST

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ADDRESS

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CITY STATE ZIP CODE

Current North Carolina

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Plate Number

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Driver License #

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Vehicle Identifica tion Number

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Year Model Make Body Style

Owner’s Certification of Liability Insurance

I CERTIFY FOR THE M OTOR VEHICLE DESCR IBED ABOVE THAT I HAVE FINANCIAL RESPONS IBILITY AS REQUIRE D BY LAW.

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PRINT OR TYPE FULL NAME OF INSURANCE COMPANY AUTHOR IZED IN N.C. – NOT AGENCY OR GROUP

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POLICY NUMBER – IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE

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SIGNATURE OF OWNER DATE OF CERTIFICATION