Application for Specialty License Plates

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LICENSE NUMBER County of Hawaii, Department of Finance Vehicle Registration & Licensing Division 101 Pauahi St., Suite No. 5, Hilo HI 96720 APPLICATION FOR SPECIALTY LICENSE PLATES In accordance with Section 249 -9.2, Hawai'i Revised Statutes, I hereby make application for one of the following types of specialty license plates (CHECK ONE): ECombat Wounded 17 Combat Veteran 17Persian Gulf Former Prisoner of War Pearl Harbor Survivor Korea Veteran Veteran 7- Other: EWorld War II Veteran EVietnam Veteran I request that the specialty license plates be assigned to my: Passenger motor vehicle bearing license number lPassenger motorcycle which is currently registered in my name. I certify that I am eligible for issuance of these specialty license plates to my vehicle pursuant to Section 249 -9.2, Hawaii Revised Statutes and the Rules and Regulations of the Director of Finance. I have attached documentary evidence of my eligibility or certification from the US Department of Veteran Affairs of the State of Hawaii Office of Veteran's Services. I am also attaching my current certificate of registration for my vehicle, required fees and periodic vehicle inspection certificate, if required. I understand that the specialty plates may be assigned to a noncommercial passenger motor vehicle or a noncommercial motorcycle or motor scooter registered in the name of the qualified applicant and shall be limited to only one category listed above, per application. I understand that prior to transferring the registered ownership of a vehicle assigned these specialty license plates, I will surrender these plates and obtain regular issued license plates. I understand that a transfer of a registered ownership out of my name will not be recorded until the specialty license plates are replaced. Unless otherwise provided by law, I understand that I must pay for all applicable taxes and fees as a condition precedent to registration and assignment of the specialty license plates. I understand that these specialty license plates will be invalid upon expiration of the current license plate change, I am responsible for re- applying for the new series of specialty license plates. Signature of Applicant /Registered Owner Print Name of Applicant /Registered Owner Date Street or P.O. Box Address City, State, Zip Code Master Appl for Spclty Plates.xls Hawai'i County is an Equal Opportunity Provider and Employer Created /Updated 7/31/2009