Form MV-412 - Application for Military and Veteran Custom Plates - New York
Personalized Passenger or Commercial Plates
The military emblem or picture will be shown on the left side of the plate. A maximum of six
spaces is allowed for the letter/number combination.
If the International Symbol of Access is required, four or five
spaces are allowed. Please call or check our website for exact space
allowances. You may provide up to three letter/number combination choices. To show a space, put a period (.) on the line in the choice where you
want the space. DMV reserves the right to reject, recall or cancel any plate that is deemed objectionable. This includes plates that have
already been issued.
1st ___ ___ ___ ___ ___ ___ 2nd ___ ___ ___ ___ ___ ___ 3rd ___ ___ ___ ___ ___ ___
o Passenger o Commercial o Motorcycle
IMPORTANT: Making a false statement in any registration application or in any proof of statements in connection with it, or deceiving or
substituting in connection with this application, is a misdemeanor under Section 392 of the Vehicle and Traffic Law, and may also result in
the revocation or suspension of the registration and/or the applicant’s license pursuant to regulations established by the Commissioner. The
act of renewing these plates shall constitute your certification that you remain eligible to continue holding these plates.
I would like to apply for:
o Standard plates (number assigned by DMV) o Personalized plates o ISA Requested (You must qualify)
Personalized Motorcycle Plates (US Veteran, Purple Heart, Vietnam Veteran and DAV only) (see DAV eligibility details
on page 1)
The military emblem or picture will be shown on the left side of the plate. A maximum of four spaces is allowed for the letter/number
combination. If the International Symbol of Access is required, only three spaces are allowed. You may provide up to three letter/
number combination choices. To show a space, put a period (.) on the line in the choice where you want the space. DMV reserves the right
to reject, recall or cancel any plate that is deemed objectionable. This includes plates that have already been issued.
1st ___ ___ ___ ___ 2nd ___ ___ ___ ___ 3rd ___ ___ ___ ___
MV-412 (8/15)
Payment Method:
o
Check
o
MasterCard
o
Discover
o
Money Order
o
Visa
o
American Express
Name (as it appears on credit card)_______________________________________________________________________
Credit Card Number ____________________________________________ Expiration Date__________________________
Authorized Signature
ç
_________________________________________________________________________________
Please do not send cash! Make the check or money order payable to “Commissioner of Motor Vehicles”.
Please allow 4 to 6 weeks for delivery. If there is an annual fee for your plate, the fee is in addition
to the renewal fee to register your
vehicle. You will be billed for the plates every two years when you renew your registration.
Return this completed form, the required proof, and payment to:
Department of Motor Vehicles, Custom Plates Unit,
PO Box 2775, Albany, NY 12220-0775
PLEASE PRINT INFORMATION BELOW
Last Name
Address (Include Street Number and Name and/or Rural Delivery Box No.)
Apt. #
Current Plate Number
Vehicle Model Year Vehicle Make
City State Zip Code
Signature (Sign Name in Full)
ç
Plate type:
Date
/ /
Daytime Phone (include area code)
( )
First M.I. Date of Birth (Month/Day/Year)
/ /
Amount Enclosed $__________________
PAGE 3 OF 3
Which military/veteran plate are you applying for? (Refer to the list on pages 1 and 2.) _________________________________________________
(Example: Former POW, Purple Heart, U.S. Veteran, etc.)
Did you remember to write down which military or Veteran plate you would like to order?
Are you receiving all of your Veterans’ benefits?
For free assistance, call the NYS Division of Veterans’ Affairs at 1-888-838-7697
Do your current plates have the
International Symbol of Access?
o Yes o No
If you need the International Symbol of Access on your new plates and you do not have it on your current plates,
you must also submit a completed form MV-664.1, which may be printed from the DMV web site.
APPLICATION FOR MILITARY AND VETERAN CUSTOM PLATES
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Form MV-412 - Application for Military and Veteran Custom Plates - New York PDF
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