1. education
2. special education

MV-904sP (9-14)
pennsylvania
DEPARTMENT OF TRANSPORTATION
M
dmv state pa us
APPLICATTON FOR SPECIAL
ORGANIZATION REGISTRATION PLATE
(PLEASE ALLOW 4-6 WEEKS FOR DEL|VERY)
Fot Deprrilment Use Only
Bureau ol l\,ilotor Vehicles . PO Box 68293
.
PA 17106-8293
(complete this section exactly as information appears on current registration card.)
Last Name (or Full Business
Name)
First
Name
Middle
Name
pA DL/photo lD#
or
Date of Birth
StreetAddress - Must list a streel address. pO Box # alone is not acceDtable.
NoTE: In conjunction with replacement of your plate, you will receive one registration card. lf additional
registriltion cards are desired, the fee is $1.50
for each card. Number of Dupricate Registration cards Requested
@ $r,so each
_,
BY ORGANIZATION OFF
NAME oF oRGANIz/\rlotN:
MISERICORDIA UNIVERSIT!
TAG T)'PE: Et)
Name of Organization, Chapter, post, Lodge, gmptoyer, etc
OFFICIAL
(See special instructions on
,"u"r""J
I certify that the individual named in Section A is a member in good standing of the organization
listed in Sectign B.
REQUEST (NOTE: Additionat $too ree nequireo.y
Personalized registration plate_choices may contain up to FIVE letters or numbers in combination. oNLy
one lryphen or space ir; permitted, bur nor
both' (lf no hyphen or space is requested, one block will remain blank.) No other special characters are ava llble. please print clearly. Additional
instructions and fees are listed on the reverse side of this application. NoTE: The pre-printed, shaded, stacked
boxes are characrers specific to this
registration plate and cannot be chanqed.
v
v
tl
U
I certify that all information given on this application is TRUE
I will immediately return the registration plate to pENNDOT.
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AND CORRECT and that when I cease to be a menrber of the above rramed organization,
APPLICANT'S SIGNATURE IN INK
GENERAT. INFORMATION REGARDTNG A SPECIAL
ORGANIZATION PLATE
. PLEASE ALLOW 4.6 WEEKS FOR DELIVERY.
Sections A' D (if
' This app
nd
in full,
turned to the orgernization official for
submissi
or' No application
to
the orga
mber wilr be processed. The organization
must com
s B and C. All app
be
DOT by
ation.
t listed in section A must b
'
d owner of the vehicle a$ inrdicated on the verhicle,:; registration
the vehicle is a leased vehicle,
"Application for Lessee Information," must
be completed and attached.
MV.1L is available on our webs
v.srate.pa.us.)
PennDor charges an issuance fee of $25' Participating organizations may
' The
charge an add tional fee above the $25 l)ennDoT fee.
organization fee is $__.
Therefore, the totil fu-" Oue with this application is
$__..
Fees must be made payabte
to the organization name of _
.
organization I
duplicated.
n registration
this applicat
replacement
and submit
I
Plate, Renewal Sticker or Weight Class Sticker,',
nt special organization registration plate can
b
.pa.us.)
'
Requests for special organization registration plates- are restricted to passenger
vehicles, tru,cks with a registered gross weight of not
more than 14'000 lbs., trailers and motor homes' Motorcycles co not qualify
'
'
No REFUND oF FEE will be issued when an applicant cancels a request afier the order is placed.
'
'
'
for special ,rrganlation registration plates.
when the applicant ceatses to be a member in the organization as listed in Section B, thr:
registration plate must be returned to
PennDoT Complete Form MV-44 and submit a fee of $tt for. the issuance of a regular
series ,Jgiitration plate.
Special organization registration plates are issued in number sequence unless
requesting porsonalization in section D.
To avoid possible problerns with citations with your old registration plate, return
it to: Bureau of Motor Vehicles, Fleturn .lag Unit, p.o.
Box 68597, Harrisburg' PA 17106-s597 after you have reieived your special organization
registration ptate.
lf applying for a Fraternal order of Police plate, the PA State Lodge seal and the pA
State Loclge Recording secrr:tary signature must
be affixed to this application.
IF PERSONALIZING YOUR SPECIAL ORGANIZATION REGIS;TRATION PLATE
'
'
Personalized Special Organization registration plates may contain up to FIVE letters and
nurnbers in cr)mbination.
A hyphen or space is not recognized as part of the registration plate configuration and
does not count as one of the letterr; or numbers.
An extra box is provided if you wish to include a hyphen or space as part 6f your configuration.
only one hyphen or spac€, is permitted,
but not both. lf you do not wish to include a hyphen or space, do not use the extra box. Nol'E: No
adclitional
special craracters are
available.
'
.
'
When requesting a numeric character of zero, please list as "g " instead of the alpha characl:er of ,,O".
PennDOT reserves the right tcl limit or reject certain requests.
Ira
lon
er
n'
r requt:st. The fee to personalize your special
the cost of your personalized iegistration
ration, please include.your completed renewal
pplication," or Form MV-140, "Request for Flegistration," and a
separate check or money order in the amount of your registration renewal fee. Payment is to be mrade by check
or money order
payable to the Commonwealth of Pennsylvania. pLEASE DO N OT SEND CASH.
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'
To check personalized registration plate availability, visit PennDOT's Driver and Vehicle Servir:es website,
www.dmv.stale.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 paynrent and er completed apprlication,
ano
approves your requested registration plate configuration [number(s) and/or lette(s)]. Please note that registratiol plate
requests are
processed on a first-come, first-served basis. Although a requested registration plate configuration
mal'ihow as being available on
the website, it is possible that a request for the same registration plate configuration may herve alreadlT been submittirJ by
another
customer ancl may not be available when making application.
Personal registration plates will be manufactured on the basis of this application. No refurrd of the fee will be issued
when an
applicant cancels a request afler the order is placed with the manufacturer.
ln state: 1-800-932-4600
Visit us at www.dmv.state.pa.us or call us at:
t Out-of-State: 1-7'17-412-5300 aTDD Out-of-State: 1-117-412-Sg8O
o TDD: 1-800-228-0676