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Get and Sign Legislative Plate Form
Plate
requested
(see reverse side for choices)
IMPORTANT INFORMATION ABOUT YOUR CHOICE
Four (4) characters are allowed for each legislative plate authorized. Your choice may include letters and
numbers as characters.
OWNER/APPLICANT IDENTIFICATION
Owner’s Name
Owner’s Sex
Date of Birth
Street Address
City
State
Owner’s Driver’s License or Identification Number
Owner’s E-Mail Address
Lessee’s Name
Lessee’s Sex
Date of Birth
Street Address
City
State
Lessee’s Driver’s License or...
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