Free MV2957 Wisconsin Women's Health Foundation License Plate Application - Wisconsin

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WISCONSIN WOMEN'S HEALTH FOUNDATION LICENSE PLATE APPLICATION
Wisconsin Department of Transportation MV2957 11/2006 s.341.14(6r)(f)57 Wis. Stats. The social security number is used for identification purposes. Give information for the vehicle that you wish to register with WHF plates.
License Plate # Year - Make Body Type Vehicle Identification #

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 WHF 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 WHF plates.

(Applicant Signature)

Personalized Message Request
First Choice
Meaning of First Choice

Personalized Plates Release

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 WHF plates, mark application and omit steps 2-4. 2. To order personalized WHF plates, choose 1-6 characters. If you choose 6 characters, no spaces are allowed. 5. If the vehicle that you wish to register with WHF 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 WHF 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 WHF 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

4 W O M E N
If you choose 5 characters, you may request up to 2 spaces between any of the characters. Indicate spaces with diagonal lines.

4 R WM N
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?

INFORMATION
When you request a Wisconsin Women's Health Foundation (WHF) plate you pay: A $15 original issuance fee, or an annual $15 personalized plate fee; (See below.) A $25 donation, which is sent to WHF. 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 WHF plates. The $25 donation may be deductible if you itemize your income tax returns. Personalized WHF Plate Available A $15 personalized plate fee is required every year in addition to the $25 donation and regular registration 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 incorrectly 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.

DRIVING TOWARD A HEALTHIER WISCONSIN
The Wisconsin Women's Health Foundation: Provides outreach and education programs to thousands of Wisconsin women each year. Supports the development of women as leaders in academic medicine and health research. Funds women's health research taking place right here in Wisconsin. The Foundation's primary areas of focus include: breast and other female cancers, osteoporosis, cardiovascular disease, smoking cessation, mental health and domestic violence. Make your donation in memory or in honor of someone. You will receive information with your license plates. For more information, contact: Wisconsin Women's Health Foundation 2303 Todd Dr. Madison, WI 53713 1-800-448-5148 or 608-251-1675 www.wwhf.org [email protected] WHF plates are available for: Automobile; Motor Home (Annual registration only); Truck: 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.

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Wisconsin Women's Health Foundation License Plate Application
Improve the health and well-being of women and families in Wisconsin by purchasing a Wisconsin Women's Health Foundation (WHF) license plate. Your $25 donation will be reinvested in communities all over Wisconsin: 50% will support Wisconsin Women's Health Foundation outreach and education programs that reach thousands of Wisconsin women and families each year. 50% will support Community Health Grants, which provide funding for community-based women's health programs in Wisconsin.

AMERICANS WITH DISABILITIES ACT
The Wisconsin Department of Transportation complies with the Americans with Disabilities Act.

RELEASE OF NONEXEMPT INFORMATION
The Wisconsin Department of Transportation uses the information on this form to issue WHF plates. Under open records laws, the Department must make nonexempt information available upon request. If you want your name withheld from mailing lists of 10 or more individuals, check yes; otherwise, check no.

Yes. No.

(Will remove your name from marketing lists.)
MV2957 Wisconsin Department of Transportation Print