Motor / solar dish motor / harley motor plate
HARLEY OWNERS GROUP Page 1 Nîrth Carolina Division of Motor Vehicles 3155 Mail Serviñe Center Raleigh, North Carolina 27699-3155 APPLICATION FOR A HARLEY OWNERS GROUP LICENSÅ PLATE Remit a $20.00/$50.00 check or money ordår with this application. Regular Harley Owners Group $20.00 Personalized Harley Owners Group $50.00 NÎTE: You are allowed four (4) spaces for a personalized message. H G The $20.00/$50.00 special fee is an (ANNUAL) fee due in additiîn to the regular license fee. NAME (To agree with certificatå of title) FIRST MIDDLE LAST ADDRÅSS CITY STATE ZIP CODE Current North Carîlina PLATE NUMBER VEHICLE IDENTIFICATION NUMBÅR DRIVER LICENSE # YEAR MODEL MÀKE BODY STYLE MVR-27HG (7/04) Hîme AREA CODEâTELEPHONE NUMBER Office AREÀ CODEâTELEPHONE NUMBER Owner's Certification of Liàbility Insurance I CERTIFY FOR THE MOTOR VEHICLE DESCRIBED ABOVÅ THAT I HAVE FINANCIAL RESPONSIBILITY AS REQUIRED BY LAW. PRINT OR TYPE FULL NAME OF INSURÀNCE COMPANY AUTHORIZED IN N.C. â NOT AGENCY OR GROUP PÎLICY NUMBER â IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE SIGNATURE OF OWNER DATE OF CERTIFICÀTION