Form Mv 911 PDF Details

The MV-911 form serves as a vital application for individuals seeking to acquire special fund registration plates in Pennsylvania, offering a unique opportunity to support various causes through the state's Department of Motor Vehicles. With options including the Wild Resource Conservation Fund, Pennsylvania Zoological Council Fund, Preserve Our Heritage, and Pennsylvania Monuments plates, applicants have the chance to contribute to conservation efforts, historical preservation, and the welfare of endangered species, among other noble initiatives. The form outlines specific fees associated with each plate type, a portion of which is allocated directly to the respective fund. Moreover, for those desiring a personalized touch to their registration plates, additional fees apply, permitting customization with up to five characters. The form also addresses requirements for leased vehicles, duplicate registration card requests, and the stipulation that motorcycles are ineligible for these special plates. Detailed instructions guide applicants through filling out the form, ensuring that vehicle and personal information is accurately captured to avoid processing delays. The process emphasizes the importance of detailed and correct submissions, as certain requests, particularly personalized plate configurations, are subject to PennDOT's approval, and fees are non-refundable once an order is placed. This initiative not only allows Pennsylvanians to display their support for various causes visibly but also plays a crucial role in funding vital projects and programs within the state.

QuestionAnswer
Form NameForm Mv 911
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesplate pennsylvania personalized, pennsylvania plates wild, plate pa personalized form, plate pa personalized

Form Preview Example

MV-911 (7-21)

www.dmv.pa.gov

APPLICATION FOR SPECIAL FUND REGISTRATION PLATE

For Department Use Only

Bureau of Motor Vehicles • P.O. Box 67900 • Harrisburg, PA 17106-7900

PLEASE CHECK (3) TYPE OF REGISTRATION PLATE REQUESTED - See reverse side for picture of registration plate

and additional information.

R

Wild Resource Conservation Fund (IY) - Fee: $38 ($15 from the fee goes toward the designated fund and an additional $112 is required for personalization.)

R

Pennsylvania Zoological Council Fund (HR) - Fee: $57 ($23 from the fee goes toward the designated fund and an additional $112 is required for personalization.)

R

Preserve Our Heritage (L6) - Fee: $57 ($23 from the fee goes toward the designated fund.) NOTE: This full color registration plate is not available for personalization.

R

Pennsylvania Monuments (IM) - Fee: $57 ($23 from the fee goes toward the designated fund and an additional

$112 is required for personalization.)

Check One: Leased Vehicle: R Yes R No NOTE: If the vehicle is a leased vehicle, Form MV-1L, “Application for Lessee Information,” must be completed and attached. Form MV-1L is available on our website at www.dmv.pa.gov.

AVEHICLE DESCRIPTION AND APPLICANT INFORMATION - Complete this section exactly as information appears on current registration card.

 

 

Title Number

 

 

Vehicle Identification Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Registration Plate Number

 

Expiration Date

 

Make of Vehicle

 

Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Name (Or Full Business Name)

First Name

 

Middle Name

PA DL/Photo ID#

Date of Birth

 

 

 

 

 

 

 

 

 

or Bus. ID#

 

 

 

 

 

 

 

 

 

 

 

 

 

Co-Owner Last Name

First Name

 

Middle Name

PA DL/Photo ID#

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

 

 

 

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

Telephone Number: Home: (

) _____________________

Work:: (

) _____________________

 

 

NOTE: In conjunction with replacement of your registration plate, you will receive one registration card. If additional registration cards are desired, the fee

is $2 for each registration card. Number of duplicate registration cards requested @ $2 each: _________.

BOPTIONAL PERSONALIZATION REQUEST - NOTE: Additional $112 fee required.

Personalized Special Fund registration plate choices may contain up to FIVE letters or numbers in combination. Pre-printed letter configurations or designated letter(s) appear on personalized registration plates based on the type of registration plate requested. Please see the reverse side of this application for additional information. Only one hyphen or space is permitted as part of the available spaces for personalization. No other special characters are available. Please use capital letters and print clearly. NOTE: The full color Preserve Our Heritage registration plate is not available for personalization.

 

FIRST CHOICE

 

SECOND CHOICE

 

 

THIRD CHOICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NOTE: When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form, after printing the form, please be sure any zero is marked with a "/."

CAPPLICANT SIGNATURE

I/We hereby certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).

Signature of Applicant

Date

 

Signature of Co-Applicant

Date

Request the Following Special Registration Plate

(Please Check Type of Registration Plate Requested on Front Side of Form)

Wild Resource Conservation Fund (WRCF)

Benefits the Management and Conservation of the Commonwealth’s Flora and Fauna.

SAMPLE

PLATE COLORS - Blue, white and yellow

You can own a vehicle registration plate that helps support the management of our wild resources to include protecting PA wildlife (which describes all forms of wildlife that are not pursued by hunters, furtakers or anglers). The number of birds, animals, fish, reptiles, and amphibians in this protected wildlife category represents 80 percent of all wildlife in PA. The Wild Resource Conservation Board has the responsibility of selecting studies and projects recommended by the state’s resource agencies, Department of Conservation and Natural Resources, PA Fish and Boat Commission, and PA Game Commission. Through generous donations, the Wild Resource Conservation Board has been able to fund many projects including reestablishing the River Otter, reintroducing the osprey, and generating a computer database of endangered and threatened species in PA. WRCF is funded entirely by donated funds from the state tax check-off, direct contributions, and from the sale of this registration plate.

For Personalized Wild Resource Conservation Fund (WRCF) registration plates, up to FIVE letters and/or numbers may be used in combination. If a hyphen or space is used as part of the registration configuration, it counts as one of the available spaces for personalization. Only one hyphen or space is permitted, but not both. No additional special characters are available. Please use capital letters and print clearly. When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form, after printing the form, please be sure any zero is marked with a "/." A pre-printed letter configuration of “RC” will precede your personalized configuration on your registration plate and cannot be changed.

Preserve Our Heritage

Benefits the educational and exhibit programs of the Pennsylvania Historical and Museum Commission.

PLATE COLORS - Brown, orange, red and white

You can have your very own registration plate commemorating Pennsylvania's proud railroading heritage. Whether you love trains, appreciate fine art, or like a unique registration plate, you’ll want this distinctive PennDOT registration plate that features Grif Teller’s famous 1928 painting When the Broadway Meets the Dawn. The painting depicts the Pennsylvania Railroad’s Broadway Limited on its Chicago to New York run as the first light of day breaks along the Juniata River in central Pennsylvania. The registration plate reproduces the rich, deep colors of Teller’s original work of art, capturing the power and speed of the onrushing locomotive. The Pennsylvania Railroad played a key role in making the commonwealth a leader in the railroading industry. The “Pennsy” story comes alive at the world-class Railroad Museum of Pennsylvania in Strasburg, Lancaster County, and in the collections of the State Archives of Pennsylvania in Harrisburg. Your support will help underwrite the educational and exhibit programs of the Pennsylvania Historical and Museum Commission. This registration plate is not available for personalization at this time.

Pennsylvania Zoological Council Fund

Benefits the Philadelphia Zoo, the Pittsburgh Zoo, the Erie Zoo, the National Aviary in Pittsburgh, the Elmwood Park Zoo in Norristown and the Lehigh Valley Zoo.

SAMPLE

PLATE COLORS - Blue, white and yellow

You can own a vehicle registration plate that helps save endangered wildlife and lets you show your support for zoos wherever you drive. Created by the Zoological Council, this registration plate pictures one of the most magnificent and endangered animals in the world - the Siberian Tiger. The Pennsylvania Zoological Council is comprised of six institutions:

The Philadelphia Zoo; the Pittsburgh Zoo; the Erie Zoo; the National Aviary in Pittsburgh; the Elmwood Park Zoo in Norristown; and the Lehigh Valley Zoo. Each institution is devoted to animal conservation and education programs. Proceeds from the sale of the registration plates will directly support these groups and their important projects, which include captive breeding of endangered species; creating bird sanctuaries on recovered wetlands; providing community education programs; constructing exciting interactive exhibits, and reintroducing endangered species into the wild. Purchase the zoo registration plate, and you immediately add your support to the efforts of the Pennsylvania Zoological Council. You’ll also show others your love for wild animals.

For Personalized Pennsylvania Zoological Council Fund registration plates, up to FIVE letters and/or numbers may be used in combination. If a hyphen or space is used as part of the registration configuration, it counts as one of the available spaces for personalization. Only one hyphen or space is permitted, but not both. No additional special characters are available. Please use capital letters and print clearly. When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form, after printing the form, please be sure any zero is marked with a "/." A pre-printed letter configuration of “PZ” will follow your personalized configuration on your registration plate and cannot be changed.

Pennsylvania Monuments

 

Benefits the Veterans Trust Fund.

 

Purchase the Pennsylvania Monuments registration plate and show your support for the cleaning, repair and restoration

 

of Pennsylvania monuments. The registration plate pictures the Pennsylvania Memorial Monument found at the Gettysburg

SAMPLE

National Military Park and displays the words “Gettysburg 1863.” Proceeds from the sale of this registration plate go

directly to the Veteran Trust Fund and will be used exclusively to provide grants to nonprofit organizations for the cleaning,

 

 

repair and restoration of Pennsylvania Monuments by the Gettysburg National Military Park.

PLATE COLORS - Blue, white and yellow

For Personalized Pennsylvania Monuments registration plates, up to FIVE letters and/or numbers may be used in

combination. If a hyphen or space is used as part of the registration configuration, it counts as one of the available spaces

 

for personalization. Only one hyphen or space is permitted, but not both. No additional special characters are available. Please use capital letters and print clearly. When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form, after printing the form, please be sure any zero is marked with a "/." A pre-printed letter configuration of "GB" will follow your personalized configuration on your registration plate and cannot be changed.

GENERAL INFORMATION

•Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. DO NOT SEND CASH. NOTE: NO REFUND of the fee will be issued when an applicant cancels a request after the order is placed.

•No Special Fund registration plate will be duplicated. If your registration plate is lost, stolen or defaced, you will need to reapply for a Special Fund registration plate by completing this application and submitting it with the appropriate fees. Should you need an immediate replacement registration plate, please complete Form MV-44, "Application for Duplicate Registration Card, Replacement of Registration Plate, or Weight Class Sticker," and submit the application to PennDOT along with a fee of $11. A standard registration plate will be issued until the replacement Special Fund registration plate can be provided.

•Requests for Special Fund registration plates are restricted to passenger cars, motor homes, trailers or trucks with a registered gross weight of not more than 14,000 lbs. Motorcycles do not qualify for Special Fund registration plates.

•This application, completed in full, along with a check or money order, should be mailed to: Bureau of Motor Vehicles, P.O. Box 67900, Harrisburg, PA 17106-7900.

•All telephone numbers will be held in confidence and used only in the event of a problem with your application.

•Special Fund registration plates are issued in sequence, unless personalized, and may not be issued with a Persons with Disability symbol.

•To avoid possible problems with citations with your old registration plate, return it to: Bureau of Motor Vehicles, Return Tag Unit, P.O. Box 68597, Harrisburg, PA 17106-8597.

IF PERSONALIZING YOUR REGISTRATION PLATE

•PennDOT reserves the right to limit or reject certain requests.

•The fee required with the application is an additional $112, and the registration on your vehicle must be current in order for PennDOT to process your request. The additional $112 fee covers the cost of your personalized registration plate order only and will not renew your vehicle's registration.

If your registration has expired or expires in the next three months, please include your completed renewal application, Form MV-105, "Pennsylvania Registration Renewal Application," or Form MV-140, “Request for Registration,” and a separate check or money order in the amount of your registration renewal fee. Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. PLEASE DO NOT SEND

CASH.

•To check personalized registration plate availability, visit PennDOT’s Driver and Vehicle Services website, www.dmv.pa.gov, and select Plate Availability from the list of services under the Online Services heading. Personalized registration plates will not be reserved until PennDOT receives payment and a completed application, and approves your requested registration plate configuration [number(s) and/or letter(s)]. Please note that registration plate requests are processed on a first-come, first-served basis. Although a requested registration plate configuration may show as being available on the website, it is possible that a request for the same registration plate configuration may have already been submitted by another customer and may not be available when making application.

•Personalized registration plates will be manufactured on the basis of this application. NO REFUND of the fee will be issued when an applicant cancels a request after the order is placed with the manufacturer.

•Allow eight to 10 weeks for delivery.

Visit us at www.dmv.pa.gov or call us at 717-412-5300. TTY callers — please dial 711 to reach us.

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