- Form MV-109 - Information and Certification for Vanpool Plates - New York
- Form MV-411 - Emergency Services Custom Plates Application - New York
- Form MV-653V - Volunteer Fire/Ambulance Company Certification of Eligibility - New York
- Form MV-1441.3 - Certification of Lost License, Permit or Plates - New York
- Form MV-440H - Historical License Plates - New York
- Form MV-414 - I LOVE NY Adventure Custom Plates Application - New York
Fillable Printable Form MV-653 - Certification of Eligibility for Official Plates - New York
Fillable Printable Form MV-653 - Certification of Eligibility for Official Plates - New York
Form MV-653 - Certification of Eligibility for Official Plates - New York
Government Division, District or Other Government Entity:
o State of New York
o County
o City
o Town
o Village
o School District
o Fire District
o Other Government Entity
PLEASE CHECK THE APPROPRIATE BOX BELOW TO INDICATE YOUR OFFICIAL GOVERNMENT STATUS:
Name of NYS Agency, County, City, Town, Village, District or Other Government Entity
Department or Division
Address
Name of Department or Division Director Business Phone Business E-Mail Address (Optional)
ATTENTION: This form is to be used by NYS political subdivisions to certify eligibility for Official plates. A political subdivision
is defined as a subdivision of New York State that has been delegated certain official functions of state or local government,
including a government entity created by, or under the authority of, State law. A vehicle assigned Official plates must be owned or
controlled by a political subdivision and operated by its employees, or specifically designated agents thereof, in the course of their
official duties. The vehicle must be titled and/or registered in the name of the political subdivision.
Volunteer organizations are
not political subdivisions, and must use form MV-653V.
I certify that the above-described vehicle(s) is (are) owned or controlled by the political subdivision to which this application for
registration applies, and that the information contained herein is true and accurate. I do so in my capacity as a duly appointed
public officer or official who has been granted the authority to act on behalf of the above-named political subdivision.
I understand that knowingly making a false statement on an application submitted to the Commissioner of Motor Vehicles is a
misdemeanor under Vehicle and Traffic Law, a misdemeanor or felony under New York State Penal Law, and may result in
criminal prosecution in addition to revocation or suspension of the registration pursuant to regulations promulgated by the
Commissioner of Motor Vehicles.
Signature ç ______________________________________________________________ Date: ________________________
Print Your Name: ______________________________________________ Title: ____________________________________
Address: ______________________________________________________________________________________________
City: _______________________________________________________________ Zip Code: __________________________
MV-653 (4/15)
(Sign Your Name in Full)
( )
DESCRIPTION OF VEHICLE(S):
o Check this box if you are certifying multiple vehicles, and attach a separate sheet listing the requested information for all vehicles.
o I am transferring plate ________________________ to this vehicle.
CERTIFICATION
DMV Supervisor Approval: ç ___________________________________________ Date: _______________________
Authorization Code ______________________
o Code from List o Code from IOCU
(Signature)
DMV USE ONLY
Your Business
E-Mail Address (optional): ____________________________________
Your Business
Phone number ______________________________
Year
Make Model
Plate Number (if currently registered)
Vehicle ID # (VIN)
POLITICAL SUBDIVISION CERTIFICATION
OF ELIGIBILITY FOR OFFICIAL PLATES
MV-653 (4/15)
Description of Vehicle(s)
YEAR MAKE MODEL VIN NUMBER
PLATE NUMBER
(if currently registered)
COUNTY OF
PRIMARY USE
