Fillable Printable Application For An American Legion License Plate

Application For An American Legion License Plate

MVR-27AL

(Revised 9/2017)

North Carolina Division of Mot or Ve

hicles

3155 Mail Service Center

Raleigh, NC 27697-3155

APPLICATION FOR AN AMERICAN LEGION LICENSE PLATE

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

I HEREBY CE

RTIFY THAT I AM A MEMBER OF THE AMERICAN LEGION. I WOULD LIKE TO M AKE

APPLICATION FO R ONE OF THE SPECI AL LICENSE PLATES BEARING THE AMERICAN LEGION.

Signed________________________________________________

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First in Flight Background

 First in Freedom Background

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Regular American Legion $10.00

 Personalized American Legion $40.00

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

When applying for a Personalized American Legion license plate, the su f fi x A L will be the last letters on the plate . T his leaves only fo ur

(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

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AR EA CODE-TE LE PHON E N U MBER

Office

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AR EA CODE-TE LE PHON E N U MBER

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 Certif ic ation of Liability Insur ance

I CERTIFY FOR THE M OTOR VEHICLE DESCRIBED ABOVE THAT I HAVE FINANCIAL RESPONSIBILITY AS RE QUIRED BY LAW.

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

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POLICY NUMBE R – IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE

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SIGNATURE OF OWNER DATE OF CERTIFICATION