Dmv 17 A Form PDF Details

If you are a new driver, or if you have just moved to a new state, you may need to get a new driver's license. As you prepare to take the DMV 17 A form, here are some things you should know. The DMV 17 A form is used to request a driving record from your previous state of residence. The driving record will show any violations or accidents that you may have been involved in while driving. It is important to be aware of any information on your driving record before taking the DMV 17 A form, as it could affect your ability to obtain a driver's license in your new state. Make sure to gather all the necessary information and submit the DMV 17 A form accurately and timely to avoid delays in getting your new driver's license.

QuestionAnswer
Form NameDmv 17 A Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdmv form reg 17a, Hawaii, dmv form 17a, 1922

Form Preview Example

STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES®

A Public Service Agency

SPECIAL LICENSE PLATE APPLICATION

ORIGINAL

Complete Sections 1, 2, 5

REPLACEMENT

Complete Sections 1, 2, 4, 5

REASSIGN, RETAIN, RELEASE

Complete Sections 1, 3, 5

Special License Plates must be assigned to a vehicle currently registered in California. The department will not honor a change of choice, spacing or a request for refund after the reservation is made.

SECTION 1 — PLATE OWNER (Please print true full name of plate owner or purchaser)

LAST NAME

FIRST NAME

MIDDLE NAME

MAILING ADDRESS (STREET OR P. O. BOX)CITYSTATEZIP CODE

SECTION 2 — TYPE OF PLATE ORDER:

Will be assigned to:

Auto

Truck

Trailer

Motorcycle (Motorcycle plates are available in Amateur Radio License, Purple

Heart, or Antique Motorcycle. Gold Star Family Motorcycle plate is available with decal.)

 

 

 

 

 

LICENSE PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER (VIN)

Plates to be placed on this vehicle, if known:

Documentation Required*

 

Certiication Required*

Documentation AND Certiication Required*

Amateur Radio License

 

 

Pearl Harbor Survivor

Congressional Medal of Honor

 

 

(PROVIDE CALL LETTERS)

 

Horseless Carriage

Honorary Consul

 

 

 

 

Legion of Valor

 

 

Press Photographer

Historical Vehicle

 

 

(TYPE OF CROSS)

 

 

 

Purple Heart Recipient

 

 

 

Antique Motorcycle

 

 

 

Gold Star Family

 

*Certify in Sections B, C, or E.

*Attach Copy of Documentation. Certify in Sections A, D,

*Attach Copy of Documentation. See reverse for explanation.

 

See reverse for explanation.

or E. See reverse for explanation.

A. CONGRESSIONAL MEDAL OF HONOR RECIPIENT CERTIFICATION

I certify that I am a Congressional Medal of Honor recipient. This vehicle is the only vehicle for which the exemption is requested; it will not be used for transportation for hire, compensation, or proit.

SIGNATURE

X

DATE

B. PEARL HARBOR SURVIVOR CERTIFICATION

The applicant was a member of the United States Armed Forces and stationed at Pearl Harbor, the island of Oahu, or offshore within a distance of three miles, on December 7, 1941, during the hours of 7:55 a.m. to 9:45 a.m., Hawaii time; and received honorable discharge from military service. Signature of an officer of the California Chapter of Pearl Harbor Survivors Association required.

OFFICER’S SIGNATURE

X

TITLE

DATE

DAYTIME PHONE NUMBER

()

C.PRESS PHOTOGRAPHER CERTIFICATION — MUST BE SIGNED BY EMPLOYER The applicant is regularly employed or engaged as a press photographer or camera person for a:

Newspaper

News Magazine

News Gathering

Newsreel Company

Television Company

EMPLOYER’S SIGNATURE

X

TITLE

DATE

DAYTIME PHONE NUMBER

()

NAME OF COMPANY

STREET ADDRESS

CITY

STATE

ZIP

D. HONORARY CONSUL CERTIFICATION

I certify that I am a citizen and/or permanent resident of the United States appointed as an honorary consul or similar official by the country listed below for the purpose of facilitating and promoting the interest of that country. I understand that these may be placed only on a vehicle owned or leased by me, and that this application is subject to review and approval by an authorized Department of Motor Vehicles employee.

SIGNATURE

X

NAME OF FOREIGN COUNTRY REPRESENTED

DATE

E.HISTORICAL VEHICLE AND HORSELESS CARRIAGE CERTIFICATION Historical Vehicle License Plates

I certify that I understand these plates may only be placed on a motor vehicle manufactured after 1922, which is at least 25 years old and is of historic interest. I also certify that I understand that the vehicle for which these plates are issued may be driven in historical exhibitions, parades, or historic club activities only.

SIGNATURE

X

DATE

Horseless Carriage License Plates

I certify that I understand these plates may only be placed on a motor vehicle manufactured in 1922 or prior, or manufactured with 16 or more cylinders before 1965. I also certify that I understand that the vehicle for which these plates are issued may be driven in historical exhibitions, parades, or historic club activities only.

SIGNATURE

X

DATE

SUBMIT ORDER AND FEES TO: DMV, SPU – MS D238, P.O. BOX 932345, SACRAMENTO, CA 94232-3450

REG 17A (REV. 7/2011) WWW

SEE REVERSE SIDE

SECTION 3 — REASSIGNMENT (Antique Motorcycle, Historical Vehicle, Horseless Carriage Plates cannot be reassigned or retained)

SPECIAL LICENSE PLATE/DISABLED PERSON LICENSE PLATE NUMBER

WERE REMOVED FROM (VIN)

PLACED ON (CURRENT LICENSE PLATE)

WITH (VIN)

RETAIN INTEREST

 

Retain for future use (Annual Fee Required for Honorary Consul Corps)

Fee enclosed

RELEASE INTEREST

Release

SECTION 4 — REPLACEMENT ONLY (To replace disabled person license plates, use form REG 156)

I NEED:

 

PLATE(S) WERE:

 

 

One Plate

Two Plates

Lost/Stolen

Mutilated

Surrendered

SECTION 5 — SIGNATURE REQUIRED FOR ALL APPLICANTS

I certify (or declare) under penalty of perjury under the laws of the State of California, that the foregoing is true and correct.

SIGNATURE

DATE

DAYTIME PHONE NUMBER

X

 

(

)

 

 

 

 

SPECIAL LICENSE PLATES

Fees subject to change based upon legislative action.

Amateur Radio

Issued to a person licensed by the Federal Communications Commission (FCC). A copy of the valid FCC license must

Station

accompany the application, the plate coniguration is the call letter. Licensee may obtain only one set of plates.

 

Fees:

Original $21

Duplicate $18

Reassignment $12

 

 

 

 

Antique

Issued to a motorcycle manufactured in 1942 or before.A copy of the vehicle registration, manufacturer’s certiicate of origin,

Motorcycle

or other documentation acceptable to the department indicating the manufacture date of the motorcycle must accompany

 

the application.

 

 

 

 

 

Fees:

Original $15

Substitute $18

 

 

 

 

 

Congressional

Recipient of the Congressional Medal of Honor, receives plates at no additional cost. Certiication on the application must be

Medal of Honor

completed. A copy of the service record, or a copy of the letter which was given to the recipient awarded the Congressional

 

Medal of Honor, must accompany the application.

 

 

 

 

Fees:

Original None

Duplicate $18

Reassignment None

 

 

 

 

Gold Star Family

Issued to family members of an active duty member of the Armed Forces killed in the line of duty. Family Members as

 

deined in Section 5156 of the Vehicle Code. The Report of Casualty (DD 1300) form from the Department of Defense,

 

and the Project: Gold Star License Plate Application (VSD 5-1918) from the California Department of Veterans Affairs must

 

accompany the application.

 

 

 

 

 

Fees:

Original None

Substitute $35

Reassignment $15

 

 

 

 

Historical Vehicle

Issued to a motor vehicle manufactured after 1922, which is at least 25 years old or older and of historic interest. Vehicle

 

may only be driven in historical exhibitions, parades, or historic vehicle club activities. For commercial vehicles only: The

 

Certiicate of Title must be submitted with the application.

 

 

 

Fees:

Original $25

Substitute $18

 

 

 

 

 

Honorary Consul

Issued to vehicle owned or leased by an honorary consular officer. A photo copy of the Consular Identiication Card issued

Corps

by the US Department of State denoting the applicant’s Honorary Consular status is required.

 

 

Fees:

Original $48

Substitute $38

Reassignment $38

Renewal $38

Retention $38

 

 

Horseless

Issued to a motor vehicle manufactured in 1922 or prior, or manufactured with 16 or more cylinders before 1965. Vehicle

Carriage

may only be driven in historical exhibitions, parades, or historic vehicle club activities.

 

 

Fees:

Original $25

Substitute $18

 

 

 

 

 

Legion of Valor

Issued to a vehicle, except motorcycle, owned by an Army, Navy, Air Force Medal of Honor, or Army Distinguished Service

 

Cross, Navy Cross, or Air Force Cross recipient. A copy of the service record or Department of Defense Form 214 must

 

accompany application.

 

 

 

 

 

Fees:

Original None

Substitute $18

Reassignment None

Substitute Decal None

 

 

 

Pearl Harbor

Issued to vehicle, except motorcycle, owned by a member of the US Armed Forces stationed at Pearl Harbor on December

Survivor

7, 1941, with an honorable discharge from military service. Certiication by officer must be completed on the application.

 

Fees:

Original None

Substitute $18

Reassignment None

 

 

 

 

Press

One set of plates issued to a vehicle owned by anyone regularly employed or engaged as a newspaper, newsreel, or

Photographer

television photographer. Certiication by employer must be completed on the application.

 

 

Fees:

Original $21

Reassignment $12

 

 

 

 

 

Purple Heart

Issued to vehicle owned by a Purple Heart recipient. Copy of orders, service record, or discharge papers showing Purple

 

Heart Award is required with application.

 

 

 

 

Fees:

Original None

Substitute $18

Reassignment None

 

 

 

 

 

 

 

 

 

NOTE: All fees and procedures for original and renewal issuance are in addition to regular registration fees pursuant to Vehicle Code Section 4000.

REG 17A (REV. 7/2011) WWW

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This document requires specific information to be typed in, therefore you should definitely take your time to provide exactly what is expected:

1. The dmv form 17a usually requires specific details to be entered. Ensure the subsequent blank fields are finalized:

Find out how to fill out FCC stage 1

2. Your next part would be to submit the next few fields: Attach Copy of Documentation See, DAYTIME PHONE NUMBER, TITLE, DATE, Newspaper, News Magazine, News Gathering, Newsreel Company, Television Company, EMPLOYERS SIGNATURE X NAME OF, TITLE, DATE, DAYTIME PHONE NUMBER, STREET ADDRESS, and CITY.

Writing part 2 of FCC

It is possible to make a mistake while filling in the DAYTIME PHONE NUMBER, consequently make sure to look again prior to when you send it in.

3. The following portion is about D HONORARY CONSUL CERTIFICATION I, DATE, REG A REV WWW, SEE REVERSE SIDE, and SUBMIT ORDER AND FEES TO DMV SPU - complete each of these empty form fields.

Best ways to fill out FCC part 3

4. To move forward, your next form section requires filling out a handful of blanks. Examples of these are SECTION REASSIGNMENT Antique, WERE REMOVED FROM VIN, PLACED ON CURRENT LICENSE PLATE, WITH VIN, RETAIN INTEREST, Retain for future use Annual Fee, Fee enclosed, SECTION REPLACEMENT ONLY To, PLATES WERE, RELEASE INTEREST, Release, One Plate, Two Plates, LostStolen, and Mutilated, which you'll find essential to moving forward with this document.

Filling in segment 4 of FCC

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