Fillable Printable Form MV-414 - I LOVE NY Adventure Custom Plates Application - New York

Form MV-414 - I LOVE NY Adventure Custom Plates Application - New York

These plates can be personalized, using as many as 6 spaces (4 for motorcycle plates). Write 3 plate number choices below.

If you want to leave a space on the plate, put a period(.) on the line where the space should be.

If the International Symbol of Access is required, only 5 spaces (3 for motorcycle plates) are allowed.

PERSONALIZATION

Choice 1 __ __ __ __ __ __ Choice 2 __ __ __ __ __ __ Choice 3 __ __ __ __ __ __

o Standard Plates:

the next available number will be assigned

o Personalized Plate:

complete step 2A below

o International Symbol of Access Requested

(you must qualify)

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SELECT THE TYPE OF DEC SPORTING LICENSE OR PARKS EMPIRE PASSPORT YOU HOLD AND DETERMINE YOUR FEE:

At the time of renewal, I LOVE NY Adventure Custom Plates are subject to a $15.00 annual ($30 total for 2 year registration) custom plate

fee that is used by the NYS Department of Economic Development to promote tourism in NYS.

For those that purchased a LIFETIME DEC sporting license or LIFETIME Parks Empire Passport in 2014, you are entitled to one (and only

one) set of Adventure Custom Plates at no charge for each LIFETIME license/passport purchased in 2014. If you have already received

your set of Adventure Custom Plates at no fee, you may order additional adventure plates at full cost. Eligibility to order Adventure Custom

Plates and eligibility to obtain the plates at no fee, if applicable, will be verified.

If you hold a:

LIFETIME DEC sporting license or LIFETIME Parks Empire Passport

purchased in 2014 - first set of adventure plates

LIFETIME DEC sporting license or LIFETIME Parks Empire Passport

purchased in 2014 - additional set of adventure plates

Passenger/Commercial registrations

Motorcycle registration

All other valid PARKS Empire Passport or valid DEC sporting

license holders

For initial plates

you pay:

(personalized

plate fee)

$ 0.00 ($ 31.25)

$ 0.00 ($ 18.75)

Passenger/Commercial registrations

Motorcycle registration

$ 43.75 ($ 75.00)

$ 31.25 ($ 50.00)

$ 43.75

$ 31.25

Passenger/Commercial registrations

Motorcycle registration

($ 75.00)

($ 50.00)

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SELECT THE TYPE OF PLATE NUMBER:

Complete application on page 2 Ô

Page 1

Passenger & Commercial

Registration Classes

Motorcycle

Registration Classes

I LOVE NY ADVENTURE CUSTOM PLATES

The I LOVE NY Adventure Custom Plates are reserved for current holders of NYS Department of Environmental Conservation (DEC) sporting

licenses and/or NYS Office of Parks and Historical Preservation (Parks) Empire Passport. To obtain the plates, you must provide a copy of your

NYS driver license or ID card, a copy of your DEC sporting license or Parks Empire Passport, and this application form, completed and signed.If

you are requesting Adventure Custom Plates for additional vehicles, please complete a separate application for each vehicle. The name on the

DEC sporting license or Parks Empire Passport must match the name on the vehicle registration the Adventure Plates are being requested for.

Return this completed form, the required proof and any payment to:

Department of Motor Vehicles, Custom Plates Unit, PO Box 2775, Albany NY 12220.

o Parks- Beach Scene o Parks - Bridge Scene

o Parks - Niagara Falls o Fishing - Striped Bass o Fishing - Walleye o Fishing - Trout

o Hunting - Deer o Hunting - Duck o Hunting - Turkey

o Parks- Beach Scene o Parks - Bridge Scene

o Parks - Niagara Falls

o Fishing - Striped Bass o Fishing - Walleye o Fishing - Trout

o Hunting - Deer o Hunting - Duck o Hunting - Turkey

Empire Passport Holders

NYS DEC Adventure License Holders

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SELECT THE I LOVE NY ADVENTURE PLATE REQUESTED

MV-414 (3/15)

Amount Enclosed

Please do not send cash!

Make check or money order payable to “Commissioner of Motor Vehicles.”

Provide separate checks/money orders when applying for plates for additional vehicles.

DETERMINE YOUR FEE USING THE CHART ON PAGE 1

Name (as it appears on credit card) _________________________________________________________

Card Account Number ______________________________________ Expiration Date ________________

Authorized Signature

_____________________________________________________

I am paying by:

o Check

o Money Order

o American Express

o Discover

o Master Card

o Visa

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Last Name

Mailing Address (Street & No., Apt. No.)

Date of Birth

/ /

Signature (Sign Name in Full)

First

City

DEC Lifetime License ID Number (if applicable) DMV Driver License ID Number

Current Plate Number Vehicle Year

Vehicle Make

State

Daytime Phone No.

( )

Date

Do your current plates have the

International Symbol of Access?

o Yes o No

If you need the International Symbol of Access on your new plates and you do not have it on your current plates,

you must also submit a completed form MV-664.1

Zip Code

By signing below, I certify that I hold a current DEC License and/or Parks Empire Passport and that I am entitled to pay the appropriate fee as

stated on the chart on Page 1 of this application. I acknowledge and understand that making a false statement in this or in any registration ap-

plication or in any proof or statements in connection with it is a misdemeanor or felony under Section 392 of the Vehicle and Traffic Law and/or

under the Penal Law, and may result in the revocation or suspension of my registrations and/or my license, and/or criminal prosecution.

NOTE:

l Please allow 4 to 6 weeks for delivery.

l Unless a personalized plate is being requested, the next available number in the plate series will be assigned.

l Falsifying documents will result in cancellation of the custom plates.

l Plates will be mailed to the address on the vehicle’s registration file. If you have moved and you have not updated your

address on your registration record, please complete the Change of Address form MV-232.

If you have any questions, or need additional information, call 518-402-4838.

--- www.dmv.ny.gov/cplates.htm ---

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FILL IN INFORMATION BELOW (Please Print):

CERTIFICATION:

Signature

- _________________________________________________________ Date ____________________

Page 2

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