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STATE OF ALASKA - DIVISION OF MOTOR VEHICLES APPLICATION FOR PERSONALIZED OR CALL SIGN LICENSE PLATES ( Print Your Full Legal Name ) Telephone Number (Daytime) Current License Plate Number Expiration Date Serial Number (VIN) Yes Year Make Plate Style Requested: Replacement Plates (reason): Body Style  BLUE/GOLD  CHOOSE LIFE  LOST No Large Is Vehicle Used Commercially?  MOUNTAIN  CARIBOU  PRO-FAMILY, PRO-CHOICE  NEW STYLE  DAMAGED 1ST Choice 2ND Choice 3RD Choice 4TH Choice 5TH Choice Trailer - Plate Size  IDITAROD FINISHER*  IN GOD WE TRUST  STOLEN Use ONLY the following in the blocks: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Small Breast Cancer NRA Ø123456789 Help reduce the cost of government - order your plates on-line: Alaska.gov/dmv Print the letters and/or numbers you want on your new license plate(s) in the blocks provided. If a space is required between characters, indicate this by leaving the block blank. Please select your choice of plate style above. THE PLATE(S) WILL BE MAILED TO THE ADDRESS SHOWN IN DMV RECORDS UNLESS YOU REQUEST OTHERWISE, IN WRITING. To change your address, write the change on the copy of the Alaska vehicle registration submitted. Provide a completed and signed Notice of Change of Address (Form 401) for other vehicles/drivers licenses that require a change of address. Enclose all of the following that apply to you:  Current registration and payment.  Address correction.  Form 830 and FCC license. (Required for call sign plates.) / Signature DMV USE ONLY: /20 Date CLASS CODE DATE BATCH AMVC / OFFICE FEE: CA CC CK STATE OF ALASKA DIVISION OF MOTOR VEHICLES 1300 W Benson Boulevard STE 200 ANCHORAGE, AK 99503-3600 Help reduce the cost of government - use the DMV website to order your personalized plate: Alaska.gov/dmv. If you request the plates over the Internet, please do not submit a paper application. Please give careful consideration before requesting your plates, as we do not issue refunds for personalized plate fees. Application for personalized or call sign plates will be accepted only for vehicles with current Alaska registration. If your vehicle is not currently registered in Alaska please register your vehicle prior to submitting an application. PLEASE DO NOT ALLOW YOUR VEHICLE REGISTRATION TO EXPIRE PRIOR TO RECEIVING YOUR PERSONALIZED PLATES. IF YOU SELL THE VEHICLE, NOTIFY DMV IMMEDIATELY. Application must be accompanied by a copy of the current Alaska registration and payment of $30.00 (personalized check or money order payable to State of Alaska). For call sign plates, there is not a charge for blue and gold license plates; however, the $30.00 fee applies if you request the Mountain or Caribou style plates. Applications for call sign plates must be accompanied by a Certificate of Eligibility (Form 830) and a current FCC license. The owner of the vehicle must sign the application. IF THERE IS MORE THAN ONE OWNER, THE PERSON WHO SIGNS THE APPLICATION WILL BE CONSIDERED THE “OWNER” OF THE PLATES. You may order a minimum of two (2) characters and a maximum of six (6) characters or characters and spaces combined. If a space is requested between any characters it will eliminate one character choice. All requests will be centered unless otherwise requested. Symbols (dashes, slashes, etc.) may not be ordered on these plates. Use ONLY the following in the blocks: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Ø123456789 To distinguish between an “O” and a “0” (zero) place a slash ( / ) through the 0 when requesting a zero (Ø). *Iditarod Finisher Plates are only available to individuals that have completed the race. Applications must be submitted in person. Identification is required. See our web site or contact DMV for further information. ALLOW 12 WEEKS FOR DELIVERY Form 803 (Rev. 02/2014) Alaska.gov/dmv