Fillable Printable Form MV-109 - Information and Certification for Vanpool Plates - New York

Form MV-109 - Information and Certification for Vanpool Plates - New York

INFORMATION AND CERTIFICATION FOR VANPOOL PLATES

To RENEW your vanpool registration plates:

- Follow the instructions provided with your renewal invitation; AND

- Complete the affidavit on page 2 of this form, and return this form with the other items requested in the renewal invitation.

To OBTAIN vanpool registration plates for an unregistered vehicle, mail the following 6 items to the address near the bottom of

this page:

1. A completed application for registration (form MV-82)

2. Proof of ownership (see form MV-82.1, “Registering A Vehicle in New York State”, for acceptable proofs of ownership)

3. Proof of sales tax payment (form FS-6T)

4. A valid Insurance Identification Card (form FS-20)

5. A blank check payable to the Commissioner of Motor Vehicles

6. The registrant of the vanpool vehicle must sign the “Certification for Vanpool Plates” on page 2 of this form,

and return it with items 1-5.

To EXCHANGE PLATES THAT ARE ALREADY ON A VEHICLE for vanpool plates, mail the following 4 items to the address

at the end of this section:

1. A completed application for registration (form MV-82)

2. A copy of the current vehicle registration

3. A blank check payable to the Commissioner of Motor Vehicles

4. The registrant of the vanpool vehicle must sign the “Certification for Vanpool Plates” on page 2 of this form,

and return it with items 1-3.

Custom Plates Unit

Department of Motor Vehicles

6 Empire State Plaza - Room 231

Albany NY 12228-0231

Special Privileges

Vehicles with vanpool plates may qualify to use special commuter lanes and parking areas. The decision to grant such privileges

is made by the branch of government that is offering the privilege, but having vanpool plates is often a requirement to qualify for

these privileges.

Eligibility Requirements

(based on Sections 158-b, 401(7) and 509-a(1) of the Vehicle and Traffic Law)

- A vehicle must be used in a vanpool operation to be eligible for vanpool plates.

“Vanpool” transportation is the prearranged transportation of persons on a regular basis to and from their places of

employment or other destination. Any payment made by passengers to the vanpool owner, lessee or operator is to be made

only to recover some or all of the expenses directly related to the transportation of the passengers (for example, tolls, fuel,

insurance and depreciation, on a not-for-profit basis).

- A vehicle must have an adult seating capacity of 6-14 passengers (this does not include the driver). Ordinary passenger

vehicles do not qualify. However, a suburban type vehicle (station wagon) can qualify if it has an adult seating capacity of

at least 6 passengers, in addition to a seat for the driver.

- We cannot issue vanpool plates to a vehicle operated under authority of the New York City Taxi and Limousine Commission,

or to a vehicle that has a currently valid operating authority permit issued by the New York State Department of

Transportation to transport cargo or passengers.

Fees

The registration fee for a vehicle that qualifies for vanpool plates is the same fee that would be charged if that vehicle was not

used for vanpooling. The annual vehicle use tax assessed by certain localities must be paid if this tax applies to the

vehicle; this tax is included in the total registration fee charged. A $50.00 title fee will be charged for a 1973 or newer model

vehicle if it does not have a NYS title, or if a NYS title for that vehicle was never issued in your name.

Note: If the vehicle is not yet registered, follow the instructions below in the “To OBTAIN” section. When the vanpool

application process is complete, we will send vanpool plates to replace the plates that are now on the vehicle.

MV-109 (9/15)

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IF YOU HAVE ANY QUESTIONS, call the Custom Plates Unit at (518) 474-6660 or (518) 474-7106.

CERTIFICATION FOR VANPOOL PLATES

I have read and understand the “Eligibility Requirements” for vanpool plates printed on page 1 of this certification.

The following required information is provided below (use a separate sheet if you need more space):

- the vehicle identification number and the year, make and model of the vehicle

- the route and geographic areas in which this vehicle will be used

- the names of the regularly-travelled highways and arterials included in these routes

- the names, addresses, pick-up locations and work locations (or other destinations) for all regular passengers

- the employer’s name and address, if different than passenger’s work location

- the approximate one-way mileage

- the time the first passenger is picked up, the time of arrival at each workplace, the time of departure from each workplace, and the time

the last passenger is dropped off.

I certify that the vehicle identified above complies with all vanpool requirements as indicated, and that the information I have provided is true

to the best of my knowledge.

ç___________________________________________________________________ ____________________________

___________________________________ ___________ ____________________________

MV-109 (9/15)

Registrant’s signature

www.dmv.ny.gov

Vehicle Identification Number Year Make/Model

Date

If you have any questions, call DMV’s Custom Plates Unit at (518) 474-6660 or (518) 474-7106.

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