[PDF] BLUE RIDGE PARKWAY FOUNDATION When applying for a Personalized





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BLUE RIDGE PARKWAY FOUNDATION

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MVR-27BP North Carolina Division

of

Motor Vehicles

3155
Mail S ervice Center

Raleigh,

North

Carolina

2769
-3155

APPLICATION FOR A

BLUE RIDGE PARKWAY FOUNDATION

LICENSE PLATE

Remit a $30.00/$60.00 check or money order with this application.

Regular Blue Ridge Parkway $30.00

Regular Blue Ridge Parkway Motorcycle $30.00

Personalized NC State Parks $60.00

Personalized Blue Ridge Parkway Motorcycle $60.00

NOTE: You are allowed four (4) spaces for a personalized message. ___ ___ ___ ___ NOTE

You are allowed

four (4) sp aces fo r a personalized message (motorcycle) _ _ _ _ When

appl ying for a Personalized Blue Ridge Parkway Foundation license plate, the suffix BP will be the last letters on the plate. When

applying

for a Personalized Blue Ridge Parkway Foundation Motorcycle license plate, the suffix BR will be the last letters on the plate.

This

leaves only four (4) spaces for a Personalized message. The four spaces may be a combination of letters and numbers, but cannot be

n umbers only. Choice cannot conflict with another class of license plates.

The $30.00/$60.00 special fee is an (ANNUAL) fee due in addition to the regular license fee. NAME(To agree with certificate of title) ________________________________________________________________

FIRST MIDDLE LAST ________

ADDRESS

________ CITY STATE ZIP CODE Home _______________________

AREA CODE-TELEPHONE NUMBER

Office

______________________

AREA CODE-TELEPHONE NUMBER

Current North Carolina

__________________

Plate Number

_________________

Driver License #

_________ ________________________________

Vehicle Identification Number

Year Model Make Body Style Owner's Certification of Liability Insurance

I CERTIFY FOR THE MOTOR VEHICLE DESCRIBED ABOVE THAT I HAVE FINANCIAL RESPONSIBILITY AS REQUIRED BY LAW.

PRINT OR TYPE FULL NAME OF INSURANCE COMPANY AUTHORIZED IN N.C. - NOT AGENCY OR GROUP POLICY NUMBER - IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE

____________________________________________________ _____________________________________________

SIGNATURE OF OWNER DATE OF CERTIFICATION

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