Form MV-414 - I LOVE NY Adventure Custom Plates Application - New York
MV-414 (3/15)
Amount Enclosed
$
Please do not send cash!
Make check or money order payable to “Commissioner of Motor Vehicles.”
Provide separate checks/money orders when applying for plates for additional vehicles.
DETERMINE YOUR FEE USING THE CHART ON PAGE 1
Name (as it appears on credit card) _________________________________________________________
Card Account Number ______________________________________ Expiration Date ________________
Authorized Signature
-
_____________________________________________________
I am paying by:
o Check
o Money Order
o American Express
o Discover
o Master Card
o Visa
}
Last Name
Mailing Address (Street & No., Apt. No.)
Date of Birth
/ /
Signature (Sign Name in Full)
-
First
City
DEC Lifetime License ID Number (if applicable) DMV Driver License ID Number
Current Plate Number Vehicle Year
Vehicle Make
MI
State
Daytime Phone No.
( )
Date
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
Zip Code
By signing below, I certify that I hold a current DEC License and/or Parks Empire Passport and that I am entitled to pay the appropriate fee as
stated on the chart on Page 1 of this application. I acknowledge and understand that making a false statement in this or in any registration ap-
plication or in any proof or statements in connection with it is a misdemeanor or felony under Section 392 of the Vehicle and Traffic Law and/or
under the Penal Law, and may result in the revocation or suspension of my registrations and/or my license, and/or criminal prosecution.
NOTE:
l Please allow 4 to 6 weeks for delivery.
l Unless a personalized plate is being requested, the next available number in the plate series will be assigned.
l Falsifying documents will result in cancellation of the custom plates.
l Plates will be mailed to the address on the vehicle’s registration file. If you have moved and you have not updated your
address on your registration record, please complete the Change of Address form MV-232.
If you have any questions, or need additional information, call 518-402-4838.
--- www.dmv.ny.gov/cplates.htm ---
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5
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FILL IN INFORMATION BELOW (Please Print):
CERTIFICATION:
Signature
- _________________________________________________________ Date ____________________
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