Application And Affidavit For Historical License Plates Form. This is a Ohio form and can be use in Bureau Of Motor Vehicles Statewide.
Tags: Application And Affidavit For Historical License Plates, BMV 4806, Ohio Statewide, Bureau Of Motor Vehicles
OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES APPLICATION AND AFFIDAVIT FOR HISTORICAL LICENSE PLATES DEFINITION, INSTRUCTIONS AND FEES ON BACK TYPE OR PRINT OHIO LICENSE PLATE # EXPIRATION DATE CERTIFICATE OF TITLE NUMBER INSPECTED BY DEPUTY NAME/DEPUTY # VEHICLE INFORMATION FROM OHIO CERTIFICATE/MEMORANDUM TITLE DATE PURCHASED YEAR MAKE MODEL SERIAL # CERTIFICATE OF TITLE # ODOMETER OWNER INFORMATION NAME D.O.B. OHIO ADDRESS DAYTIME PHONE # CITY SSN/TIN/OH DL/OH ID STATE ZIP CODE OHIO VEHICLE OWNERSHIP Single Joint Leased OWNER BUSINESS ADDRESS JOINT OWNER/LESSEE NAME SS # OHIO COUNTY OF RESIDENCE Company CITY IS YOUR LICENSE PLATE REGISTRATION UNDER SUSPENSION OR REVOCATION UNDER OHIO FINANCIAL RESPONSIBILITY LAW? YES STATE ZIP CODE NO IF REGISTRATION OR PLATES ARE TO BE MAILED TO A DIFFERENT ADDRESS FROM THAT ABOVE, FILL IN THE FOLLOWING: STREET CITY STATE ZIP CODE Historical license plates’ character combinations can also be personalized or reserved. The registrar is required by law to collect an ADDITIONAL ANNUAL FEE over and above the one-time fee assessed for regular stock (preassigned numbers only) historical plates. INDICATE YOUR CHOICES TO REQUEST RESERVED OR PERSONALIZED HISTORICAL PLATES If you want stock plates (preassigned numbers only), DO NOT submit choices. The first available choice will be assigned. There is a MAXIMUM of 6 characters including spaces on historical license plates. Six character combinations are permitted to have one full space. Four or five character combinations are permitted up to 3 spaces. Standard manufacturing procedures do no permit a choice of spacing for reserved license plates. If 3 spaces are requested on 5 character plates, the spacing is actually only 1/4 space. On 4 character combinations, the spacing can be up to 1/2 space if the maximum of 3 spaces is requested. Leave a box empty to indicate a space for reserved or personalized plates. If there are not enough spaces in the boxes below, indicate desired spaces with a slash between characters. Dashes, symbols and punctuation marks cannot be used. There is a MAXIMUM of 4 characters on motorcycle plates. Inappropriate requests will not be issued. LETTERS MAY NOT BE USED IN THE MIDDLE OF NUMBERS. HISTORICAL PLATES MAY BE OBTAINED AT YOUR LOCAL DEPUTY REGISTRAR OR BY CONTACTING THE BMV, SPECIAL PLATES AT 1-800-589TAGS. FIRST CHOICE THIRD CHOICE SECOND CHOICE FOURTH CHOICE SEE REVERSE SIDE FOR IMPORTANT INFORMATION REGARDING INSTRUCTIONS AND FEES. *AFFIDAVIT* I, X (owner signature), being first duly sworn, state that I am the owner of the above motor vehicle which is more than 25 years old. I certify that the vehicle has been inspected and found safe to operate on the highways of the state. I certify that the vehicle is owned solely as a collector’s item and for participation in club activities, exhibitions, tours, parades, and similar uses, but in no event is it to be used for general transportation. SEAL Sworn to before me and signed in my presence this NOTARY PUBLIC SIGNATURE day of MY COMMISSION EXPIRES X BMV 4806 1/11 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com DEFINITION AND INSTRUCTIONS HISTORICAL VEHICLES OHIO REVISED CODE (R.C.) 4503.181 Motor vehicles must be at least 25 years old to qualify. They are solely collector’s items and are used for participation in club activities, exhibitions, tours, parades, etc. but NOT for general transportation. Historical license plates are valid without renewal for the life of the vehicle, except Initial/Personalized or when there is a change in ownership. In that case, the plates must be surrendered to the Registrar of the Ohio Bureau of Motor Vehicles. If the vehicle has a regular Ohio vehicle registration, there will be no refund or partial refund for your current vehicle registration. Your registration and plates will be mailed within seven to ten days. Failure to follow instructions will delay the issuance of your registration. THE FOLLOWING ITEMS ARE REQUIRED TO PURCHASE HISTORICAL LICENSE PLATES. 1. 2. 3. 4. Total amount due. Make check or money order payable to: Ohio Treasurer Josh Mandel. Current OHIO vehicle registration card for above vehicle. If registration card is unavailable, send Certificate of Title or Memorandum Title (original document only). You may take these documents to any deputy registrar agency to be verified for a fee of $3.50. The deputy may process the plates as well. Affidavit must be completed and notarized. Completed and signed application. FEES The R.C. 4503.19 requires that you ADD $7.50 for a set of license plates and $6.50 for a single plate to the below fees for replacement plates if your vehicle is currently registered or has been registered within the last 12 months. If requesting reserved personalized historical license plates, ADD the appropriate fee to the below one-time permanent registration. You will be billed annually for the reserved or personalized fee. th Your plates will expire on your date of birth; if company owned your plates will expire on the 20 of the month. REQUIRED FEE ADD PERMISSIVE TAX DEPUTY REGISTRAR FEE POSTAGE TOTAL AMOUNT DUE $ $ $ $ $ RESERVED- $25.00 Standard manufacturing procedure does not permit a choice of spacing for this type of license plate. LETTERS MAY NOT BE USED IN THE MIDDLE OF NUMBERS. THREE LETTERS ONLY THREE LETTERS BEFORE OR AFTER 1 THRU 9 ONE LETTER BEFORE AND AFTER 1 THRU 9999 ONE LETTER BEFORE OR AFTER 1 THRU 99999 TWO LETTERS ONLY TWO LETTERS BEFORE OR AFTER 1 THRU 9999 NUMBERS ONLY 28801 THRU 999999 PERSONALIZED- $50.00 Personalized license plates must contain no less than four letters and no more than six letters or combination of four letters with numbers. You are now able to make a $1.00 donation to the Children’s Save Our Sight Program by checking the appropriate box below and adding an additional $1.00 to your total fees due. For Further information regarding this program, please call 1-800-755-GROW (4769). Yes, I would like to donate to the Children’s Save Our Sight Program. I have added a $1.00 to the total due. PROOF OF FINANCIAL RESPONSIBILITY YOU WILL LOSE YOUR DRIVER LICENSE FOR AT LEAST 90 DAYS IF YOU DRIVE WITHOUT INSURANCE OR OTHER FR PROOF In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage. It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage. PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket At all vehicle inspection stops Upon traffic court appearances and Upon random checks by the Registrar of Motor Vehicles. ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license for 90 DAYS on first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of $100.00 for first offense, $300.00 for second offense, $600.00 for third and subsequent offenses Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS. ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS. IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied). THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: AN INSURANCE POLICY showing automobile liability insurance of at least $12,500 bodily injury per person, $25,000 injury two or more persons, and $7,500 property damage AN INSURANCE IDENTIFICATION CARD (same coverage) A SURETY BOND OF $30,000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles. I affirm that the owners (or lessees or leased vehicle) now have insurance or other proof of financial responsibility (FR coverage) covering this vehicle and will not operate or permit the operation of this vehicle without FR coverage; and will be used as a commercial vehicle unless so registered. WARNING: Applicant giving false information is subject to prosecution R.C. 2913.42. Application must be signed by the owner(s) as named on Certificate of Title. OWNER(S) SIGNATURE DATE X Mail to: OHIO BUREAU OF MOTOR VEHICLES, ATTN: REGISTRATION SECTION, P.O. Box 16521, Columbus, Oh 43216-6521 Phone (614) 752-7800. This form may be found on the Web site: www.bmv.ohio.gov BMV 4806 1/11 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com