Mva Form Vr 164 – Fill Out and Use This PDF

MOTOR VEHICLE ADMINISTRATION

6601 Ritchie Highway, N.E.VR-164 (03-13) Glen Burnie, Maryland 21062

Application for Special Registration Plates

Owner’s Name - First		Middle		Last
Co-Owner’s Name - First		Middle		Last
Owner’s Street Address
City		County	State	Zip Code
Year	Make	Vehicle Identification Number		MD. Title Number
MD. Tag No.	Sticker No.	Sticker Year		Daytime Telephone Number
Insurance Company		Policy/Binder No.	Agent/Broker

For personalized plates provide 1st, 2nd, 3rd, and 4th choices below.

For Amateur Radio Operator registration, place your FCC assigned call letters in the space of choice #1. Personalized registration plates may not contain more than seven (7) letters, numbers and spaces in combination.

Motorcycle and Individual with a Disability personalized plates may not contain more than six (6) letters, numbers and spaces in combination.

1st

2nd

3rd

4th

Please complete this section if the choice of personalized plates above are being relinquished

I/we

hereby relinquish personalized

plate #

for re-issuance to

Signature

Date

Signature of Owner

Date

Signature of Co-Owner

Date

Printed Name of Owner

Printed name of Co-Owner

Certification:

Signature of Owner

I/we certify, under penalty of law, that the

statements made herein are true and

Printed Name of Owner

correct to the best of my/our

knowledge, information and belief.

Witness my/our Hand(s) and Seal(s)

Signature of Co-Owner

This

day of

20

Printed Name of Co-Owner

White - Department of Origin

Canary - Accounting

Pink - Customer

Goldenrod - Personalized Plates

For more information, please call: 410-768-7000 (to speak with a customer service representative).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: www.MVA.Maryland.gov

Amateur Radio Operator Registration Plates:

1.The owner of a vehicle of the following classes may apply for Amateur Radio Operator Registration: Class “A” (passenger cars), Class “E” (Trucks, 1 ton or less), and Class “M” (Multi-purpose vehicles).

2.A valid copy of your FCC Amateur Radio Operator’s license and a copy of your present registration card must accompany this application.

3.If applying for Disability Amateur Radio Operator’s plates the applications must be accompanied by a completed Application for Maryland parking placards/license plates for Individuals with a Disability (VR-210), signed by a certified licensed physician or a copy of the current certification.

4.An annual fee of five dollars ($5.00) is made payable with the original and each renewal application. This additional fee may not be prorated.

Personalized Registration Plates:

1.The owner of a vehicle of the following classes may apply for Personalized Registration Plates:

Class “A” (passenger cars), Class “D” (Motorcycle), Class “E” (Trucks, 1 ton or less), Class “G” (Non-freight Trailer) Class “M” (Multi-purpose vehicles), Class “L” (Historic), and Class “N” (Street Rod).

Disability personalized plates are available for Class “A” (passenger cars), Class “E” (Trucks, 1 ton or less), and Class “M” (Multi-purpose vehicles).

2.A Personalized registration plate may consist of any combination of not more than seven (7) letters, numbers and spaces.

Motorcycle and Individual with a Disability personalized plates may consist of any combination of not more than six (6) letters, numbers and spaces.

3.A personalized plate may not contain any symbol, diagram, slash or other character.

4.An additional annual fee of fifty dollars ($50.00) is made payable with the original and each renewal application. For a two (2) year registration or renewal, the fee is one hundred dollars ($100.00). This additional fee may not be prorated. There will be an additional $20.00 fee for substitute special registration plates.

5.A personalized plate issued shall be reserved from registration year to registration year provided that the applicant renews the special registration within six (6) months of expiration and pays all applicable fees.

6.An application for Disability personalized plates must be accompanied by a completed Application for Maryland parking placards/license plates for Individuals with a Disability (VR-210), signed by a certified licensed physician or a copy of the current certification.

7.The application for personalized plates must be accompanied by a copy of the current registration card.

8.A historic motor vehicle 60 years or older does not qualify for special registration plates as they require an annual registration fee.

General Information:

1.The Administration has authority to limit or reject certain requests for special registration plates.

2.Only one Amateur Radio Operator registration will be issued to any one applicant during a registration year.

3.A valid copy of the FCC Amateur Radio Operator’s license must accompany each registration renewal.

4.Amateur Radio Operator registration plates must be surrendered immediately upon suspension of the FCC license.

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