Section A - Vehicle Owner Information
DO NOT WRITE ABOVE THIS LINE.
TEMPORARY LICENSE PLATE APPLICATION 30 Day Operating Permit
MV2505 11/2004 s.341.09 Wis. Stats.
Mail To: Wisconsin Department of Transportation Research and Information PO Box 8070 Madison WI 53708-8070 Make Check Payable To: Registration Fee Trust
Complete form using BLUE or BLACK ink.
Application Type
In-person Fee: $3.00 plus $5.00 counter service fee Temporary license plates may be received immediately at any DMV Service Center which provides registration service.
Mail
Fee: $3.00 Temporary license plates are
usually mailed within three (3) working days
of receipt of the application.
License Plate Number
Vehicle Identification Number
Vehicle Year, Make
Print Owner Name - Last, First, Middle Initial
Area Code - Telephone Number Between 7:30 a.m. and 4 p.m.
Street Address
City
State
ZIP Code
I request a temporary plate for the vehicle listed above because:
The vehicle failed the emission test and is being repaired. Other - Explain
X
(Owner Signature) (Date)
The Wisconsin Department of Transportation complies with the Americans with Disabilities Act. The Area Below Is For Office Use ONLY Plate Number Issued Effective Date Expiration Date
Total Amount Collected
Financial Number
Badge Number