MV-911 (10-14)
APPLICATION FOR SPECIAL FUND
REGISTRATION PLATE
www.dmv.state.pa.us
For Department Use Only
Bureau of Motor Vehicles • P.O. Box 67900 • Harrisburg, PA 17106-7900
plEasE CHECK TYpE OF plaTE rEquEsTED - See reverse side for picture of plate and additional information.
r Wild Resource Conservation Fund (S3/IY) - Fee: $35 ($15 from the fee goes toward the designated fund.)
r Pennsylvania Zoological Council Fund (HR) - Fee: $54 ($23 from the fee goes toward the designated fund.)
r Preserve Our Heritage (L6) - Fee: $54 ($23 from the fee goes toward the designated fund.)
r Pennsylvania Monuments (IM) - Fee: $54 ($23 from the fee goes toward the designated fund.)
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.state.pa.us.
a
VEHIClE DEsCrIpTION aND applICaNT INFOrMaTION (Complete this section exactly as information appears on current registration card.)
Vehicle Identification Number
Title Number
Current Expiration
Current Registration Plate Number
Make of Vehicle
Last Name (Or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
Or Bus. ID#
Date of Birth
Co-Owner Last Name
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
City
Street Address
Telephone Number:
B
(Home)
(
) _____________________ (Work)
(
State
Zip Code
) ______________________
NOTE: In conjunction with replacement of your plate, you will receive one registration card. If additional registration cards are desired, the fee is $1.50
for each card. Number of Duplicate registration Cards requested @ $1.50 each _________.
OpTIONal pErsONalIzaTION rEquEsT (NOTE: Additional $100 Fee Required.)
Personalized registration plate choices may contain up to FIVE letters or numbers in combination. Only one hyphen or space is permitted as part of the
available spaces for personalization. No other special characters are available. Please print clearly. NOTE: The Preserve Our Heritage registration plate
is not yet available for personalization.
FIRST CHOICE
C
Year
SECOND CHOICE
THIRD CHOICE
applICaNT 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
gENEral INFOrMaTION
Signature of Co-Applicant
Date
• 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 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 plate, please complete Form MV-44,
"Application for Duplicate Registration Card, Replacement of Registration Plate, Renewal Sticker or Weight Class Sticker," and submit the application to
PennDOT along with a fee of $11. A standard plate will be issued until the replacement Special Fund 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 plate, return it to: Bureau of Motor Vehicles, Return Tag Unit, P.O. Box 68597, Harrisburg, PA 17106-8597.
request the Following special registration plate:
(Please Check Type of Plate Requested on Front Side of Form)
pennsylvania Wild resource Conservation
Benefits the Management and Conservation of the Commonwealth’s Flora and Fauna.
Plate Colors - Blue, yellow, purple and white
Plate Colors - Blue, white and yellow
The Wild Resource Conservation Fund (WRCF) was established to give Pennsylvanians the opportunity to support
the management of our wild resources. These include protected 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 class represents 80 percent of all wildlife in PA. The WRCF Act includes native wild
plants. The administration of the WRCF is by an unpaid seven member board and a volunteer 10-member advisory
committee appointed by the board. 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 following
are some of the projects funded: reestablish the River Otter; reintroduce the osprey; a computer database of
endangered and threatened species of PA; research on endangered and threatened amphibians and reptiles of PA;
numerous educational booklets and documentary videos. The WrCF is funded entirely by donated refunds from
the state tax check-off, direct contributions, and from the sale of the registration plate. NOTE: Personalized
WRCF registration plates depict the River Otter in an image on the left side of the registration plate.
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.
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.
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.
pennsylvania Monuments
Benefits the Veterans Trust Fund.
Plate Colors - Blue, white and yellow
Purchase the Pennsylvania Monument 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 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.
IF PERSONALIZING YOUR REGISTRATION PLATE
• Personalized Special Fund registration plates may contain up to FIVE letters and numbers in combination. NOTE: The Preserve Our Heritage registration plate
is not yet available for personalization.
• If a hyphen or space is used as part of the registration plate configuration, it counts as one of the available spaces for personalization. Only one hyphen or
space is permitted, but not both. NOTE: No additional special characters are available.
• When requesting a numeric character of zero, please list as "Ø" instead of the alpha character of "O".
• PennDOT reserves the right to limit or reject certain requests.
• The fee required with the application is an additional $100, and the registration on your vehicle must be current in order for PennDOT to process your request.
The additional $100 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.state.pa.us and select the Personalized
Registration Plate Availability link from the list of services under the Online Driver and Vehicle 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.state.pa.us or call us at:
In state: 1-800-932-4600 u TDD: 1-800-228-0676 u Out-of-State: 1-717-412-5300 u TDD Out-of-State: 1-717-412-5380