Free MV2916 Ducks Unlimited License Plate Application - Wisconsin

DUCKS UNLIMITED LICENSE PLATES APPLICATION
MV2916 6/2008 s.341.14(6r) Wis. Stats.


Wisconsin Department of Transportation

Clear Form
Vehicle Identification #

The social security number is used for identification purposes.
Give information for the vehicle that you wish to register with DUK plates.

License Plate # Year - Make Body Type

Owner(s)/Lessee Name (Last, First, M.I.) - Print

Social Security # or Driver License # or (If company owned) FEIN #

Street Address

City

State

ZIP Code

Check Options
_____ I would like personalized DUK plates
Note: If all personalized choices have been used
_____ I would like nonpersonalized plates
_____ Call me at _________________________
between 7 a.m. and 4:30 p.m. _____ E-mail me at ________________________ _____ I would like nonpersonalized DUK plates.

(Applicant Signature)

Personalized Message Request
First Choice
Meaning of First Choice

Personalized Plates Release

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I authorize the re-issuance of my personalized license plate number specified above. Second Choice
Meaning of Second Choice

I allow the DOT to reissue my current personalized plate after it is replaced with a different plate.

Third Choice
Meaning of Third Choice (Signature of Owner Releasing Plate)

New Owner - please check one: Have plates in good condition in my possession Need new plates issued
Note: No credit of any fees from former owner is allowed.


How to Apply
1. To order nonpersonalized Ducks Unlimited (DUK) plates, mark application and omit steps 2-4. 2. To order personalized DUK plates, choose 1-6 characters. If you choose 6 characters, no spaces are allowed. 5. If the vehicle that you wish to register with DUK
plates is already titled in your name, send:
* A copy of your Certificate of Registration OR the complete vehicle description on the application above; * $15.00 issuance or personalized plate fee, $25.00 DUK donation, plus the annual registration fee if the current plates expire within the next 3 months. 6. If the vehicle is NOT titled in your name, send: * A completed title application (MV1 or MV11) and fees, including annual registration fee; * Additional $15.00 issuance or personalized plate fee, and $25.00 DUK donation. 7. Make check or money order payable to: Registration Fee Trust. 8. Mail all required items to:
Wisconsin Department of Transportation
Special Plates Unit
PO Box 7911
Madison, WI 53707-7911


D U C K S 1
If you choose 5 characters, you may request up to 2 spaces between any of the characters. Indicate spaces with diagonal lines.

S A V E M
3. Use capital letters or numbers. The letter O and the number zero are the same. The following are not acceptable: small letters, symbols, signs, hyphens, apostrophes, etc. Carefully distinguish between: Letters L or I and Number 1 Letter Z and Number 2 Letter S and Number 5 Letter B and Number 8 Letter G and Number 6 Letter U and Letter V 4. Provide meaning of request, i.e., what does this represent?

Clear Form

Plate Donation Benefits Wildlife Conservation The first time you request a Ducks Unlimited plate you pay: A $15 original issuance fee, or an annual $15 personalized plate fee; (See below.) A $25 donation, which supports
conservation programs funded by Ducks
Unlimited;
Your regular registration fee, if your current plates expire within 3 months. Thereafter, you will pay the $25 donation and the regular registration fee for standard Ducks Unlimited plates. The $25 donation may be tax deductible for certain tax filers; consult your tax advisor. Personalized Ducks Unlimited Plates Available A $15 personalized plate fee is required every year in addition to the $25 donation and regular registra tion fee. If your personalized request is not available, check which option on the form you would like us to follow. WDOT may refuse to issue OR may recall after issuance, a request that is misleading or may be offensive to good taste or decency. No refund or adjustment will be made for a change of choice or spacing after the plate has been ordered, or if the application is unclear or incor rectly completed. Plates will be mailed 4-6 weeks after you receive the new Certificate of Registration. Plates Required in 2 days To legally operate your vehicle, you must display license plates within 2 business days of purchase. If you do not have current plates, apply to a DMV Customer Service Center or an agent authorized by DMV to obtain a temporary plate while your order is processed. An agent may also charge a $3 plate fee and/or may charge a $5 service fee. If you have questions: Call 608-266-3041; FAX 608-267-5106; E-mail: [email protected]; Write to the address given inside.

PLATES BENEFIT WETLANDS Ducks Unlimited works to conserve wetlands in North America. Since its founding in 1937, the organization has helped conserve more than 9.4 million acres of prime wetland and wildlife habitat. The purchase of Ducks Unlimited license plates will support habitat enhancement projects which benefit waterfowl and promote the health of hundreds of other wildlife species, including many of the world's endangered species. It also entitles you to a oneyear membership in the organization (accepting membership reduces the amount of your donation that may be tax-deductible). For more information about Ducks Unlimited, Inc. visit www.ducks.org or call 1-800-453-8257 (1-800-45DUCKS).

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Ducks Unlimited License Plate Application
Ducks Unlimited Plates are available for: Automobiles Motor Homes (annual registration only) Motor Trucks
4,500, 6,000 or 8,000 pound gross weight including dual purpose farm and dual purpose motor home 12,000 pound gross weight farm truck

RELEASE OF NONEXEMPT INFORMATION The Wisconsin Department of Transportation uses the information on this form to issue Ducks Unlimited license plates. Under open records laws, the Department must make nonexempt information available upon request. Do you want your name withheld from mailing lists of 10 or more individuals? Yes No

ADA - The Wisconsin Department of Transportation complies with the Americans with Disabilities Act

This will remove your name from marketing lists.


Wisconsin Department of Transportation
MV2916 6/2008