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Form MV-400PH.1 - Request for Plates for a Disabled Veteran - New York

1 Form MV-400PH.1 - Request for Plates for a Disabled Veteran - New York
2 Form MV-400PH.1 - Request for Plates for a Disabled Veteran - New York
New York State Department of Motor Vehicles
REQUEST FOR PLATES FOR A
DISABLED VETERAN
DO NOT WRITE IN THIS SPACE
(For DMV Use Only)
DO NOT WRITE IN THIS SPACE
(For DMV Use Only)
Please print all information on this form.
Enter the following information about the vehicle on which you will
use the disabled veteran plates:
o Please check here if you already have plates for the disabled.
Current Plate
Number
Expiration
Date
Name in which Vehicle is now Registered
Street Address (Include Street Number and Name and/or Rural Delivery Box No.) Apt. No.
City State Zip Code
Daytime Phone (include area code)
( )
Date of Birth
/ /
Send this completed form, and items 1 - 4 listed on page 1 of this form, to:
Custom Plates Unit
New York State Department of Motor Vehicles
PO Box 2775
Albany NY 12220-0775
Name (as it appears on credit card) __________________________________________________________________________
Card Account Number_________________________________________________Expiration Date ______________________
Authorized Signature ç ____________________________________________________________________________________
If you have any questions, please call 1-518-402-4838, or visit DMV on-line at: www.dmv.ny.gov.
MV-400PH.1 (4/11)
PAGE 2 OF 2
Payment: Please do not send cash! Check the box below for the payment method you are going to use. A check or money order
must be made payable to Commissioner of Motor Vehicles. If you are paying by credit card, provide the credit card information
required below and sign on the Authorized Signature line.
o Check o Money Order o MasterCard o Visa o Discover o American
Express
Amount Enclosed
$_______________
Page 2/2
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Form MV-400PH.1 - Request for Plates for a Disabled Veteran - New York PDF

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