MV-911 (7-17)
APPLICATION FOR SPECIAL FUND
REGISTRATION PLATE
www.dmv.pa.gov
For Department Use Only
Bureau of Motor Vehicles • P.O. Box 67900 • Harrisburg, PA 17106-7900
PlEasE CHECK (3) TYPE OF rEgIsTraTION PlaTE rEquEsTED - See reverse side for picture of registration plate
and additional information.
r Wild Resource Conservation Fund (S3) - Fee: $36 ($15 from the fee goes toward the designated fund.) NOTE: This
full color registration plate is not available for personalization.
r Personalized Wild Resource Conservation Fund (IY) - Fee: $36 ($15 from the fee goes toward the designated fund
and an additional $104 is required for personalization.)
r Pennsylvania Zoological Council Fund (HR) - Fee: $55 ($23 from the fee goes toward the designated fund and an
additional $104 is required for personalization.)
r Preserve Our Heritage (L6) - Fee: $55 ($23 from the fee goes toward the designated fund.) NOTE: This full color
registration plate is not available for personalization.
r Pennsylvania Monuments (IM) - Fee: $55 ($23 from the fee goes toward the designated fund and an additional
$104 is required for personalization.)
Check One: Leased Vehicle: r Yes r No NOTE: If the vehicle is a leased vehicle, Form MV-1L, “Application for Lessee
Information,” must be completed and attached. Form MV-1L is available on our website at www.dmv.pa.gov.
a
VEHIClE DEsCrIPTION aND aPPlICaNT INFOrMaTION - Complete this section exactly as information appears on current registration card.
Vehicle Identification Number
Title Number
Expiration Date
Registration Plate Number
Make of Vehicle
Last Name (Or Full Business Name)
First Name
Middle Name
PA DL/Photo ID#
or Bus. ID#
Date of Birth
Co-Owner Last Name
First Name
Middle Name
PA DL/Photo ID#
Date of Birth
City
Street Address
Telephone Number:
B
(Home)
(
) _____________________ (Work)
(
State
Zip Code
) ______________________
NOTE: In conjunction with replacement of your registration plate, you will receive one registration card. If additional registration cards are desired, the fee
is $2 for each card. Number of Duplicate registration Cards requested @ $2 each _________.
OPTIONal PErsONalIzaTION rEquEsT (NOTE: Additional $104 Fee Required.)
Personalized Special Fund registration plate choices may contain up to FIVE letters or numbers in combination. Pre-printed letter configurations or
designated letter(s) appear on personalized registration plates based on the type of registration plate requested. Please see the reverse side of
this application for additional information. Only one hyphen or space is permitted as part of the available spaces for personalization. No other
special characters are available. Please use capital letters and print clearly. NOTE: The full color Preserve Our Heritage registration plate is not
available for personalization.
FIRST CHOICE
C
Year
SECOND CHOICE
THIRD CHOICE
NOTE: When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable
form, after printing the form, please be sure any zero is marked with a "/."
aPPlICaNT sIgNaTurE
I/We hereby certify under penalty of law that ALL information contained herein is TRUE and CORRECT and that I/we understand that any misstatement
of fact is a misdemeanor of the third degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).
Signature of Applicant
Date
Signature of Co-Applicant
Date
request the Following special registration Plate
(Please Check Type of Registration Plate Requested on Front Side of Form)
Wild resource Conservation Fund (WrCF)
Benefits the Management and Conservation of the Commonwealth’s Flora and Fauna.
Plate Colors - Blue, yellow, purple and white
You can own a vehicle registration plate that helps support the management of our wild resources to include protecting PA
wildlife (which describes all forms of wildlife that are not pursued by hunters, furtakers or anglers). The number of birds,
animals, fish, reptiles, and amphibians in this protected wildlife category represents 80 percent of all wildlife in PA. The Wild
Resource Conservation Board has the responsibility of selecting studies and projects recommended by the state’s
resource agencies, Department of Conservation and Natural Resources, PA Fish and Boat Commission, and PA Game
Commission. Through generous donations, the Wild Resource Conservation Board has been able to fund many projects
including reestablishing the River Otter, reintroducing the osprey, and generating a computer database of endangered and
threatened species in PA. WRCF is funded entirely by donated funds from the state tax check-off, direct contributions, and
from the sale of this registration plate. NOTE: This full color design registration plate is not available for
personalization. see the below blue, white and yellow WrCF registration plate for personalization.
Personalized Wild resource Conservation Fund (WrCF)
Benefits the Management and Conservation of the Commonwealth’s Flora and Fauna.
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S
Plate Colors - Blue, white and yellow
Preserve Our Heritage
For Personalized Wild resource Conservation Fund (WrCF) registration plates, up to FIVE letters and/or numbers may
be used in combination. If a hyphen or space is used as part of the registration configuration, it counts as one of the
available spaces for personalization. Only one hyphen or space is permitted, but not both. No additional special characters
are available. When requesting a numeric character of zero, please list as "0" instead of the alpha character of "O". A preprinted letter configuration of “rC” will precede your personalized configuration on your registration plate and cannot be
changed. NOTE: Only this blue, white and yellow WRCF registration plate is available for personalization. Personalized
WRCF registration plates depict the River Otter in an image on the left side of the registration plate and is not available in
the full color design.
Benefits the educational and exhibit programs of the Pennsylvania Historical and Museum Commission.
Plate Colors - Brown, orange, red and white
You can have your very own registration plate commemorating Pennsylvania's proud railroading heritage. Whether you
love trains, appreciate fine art, or like a unique registration plate, you’ll want this distinctive PennDOT registration plate that
features Grif Teller’s famous 1928 painting When the Broadway Meets the Dawn. The painting depicts the Pennsylvania
Railroad’s Broadway Limited on its Chicago to New York run as the first light of day breaks along the Juniata River in
central Pennsylvania. The registration plate reproduces the rich, deep colors of Teller’s original work of art, capturing the
power and speed of the onrushing locomotive. The Pennsylvania Railroad played a key role in making the commonwealth
a leader in the railroading industry. The “Pennsy” story comes alive at the world-class Railroad Museum of Pennsylvania
in Strasburg, Lancaster County, and in the collections of the State Archives of Pennsylvania in Harrisburg. Your support
will help underwrite the educational and exhibit programs of the Pennsylvania Historical and Museum Commission. This
registration plate is not available for personalization at this time.
Pennsylvania zoological Council Fund
Benefits the Philadelphia Zoo, the Pittsburgh Zoo, the Erie Zoo, the National Aviary in Pittsburgh, the Elmwood Park Zoo in Norristown and the Lehigh Valley Zoo.
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Plate Colors - Blue, white and yellow
You can own a vehicle registration plate that helps save endangered wildlife and lets you show your support for zoos
wherever you drive. Created by the Zoological Council, this registration plate pictures one of the most magnificent and
endangered animals in the world - the Siberian Tiger. The Pennsylvania Zoological Council is comprised of six institutions:
The Philadelphia zoo; the Pittsburgh zoo; the Erie zoo; the National aviary in Pittsburgh; the Elmwood Park zoo
in Norristown; and the lehigh Valley zoo. Each institution is devoted to animal conservation and education programs.
Proceeds from the sale of the registration plates will directly support these groups and their important projects, which include
captive breeding of endangered species; creating bird sanctuaries on recovered wetlands; providing community education
programs; constructing exciting interactive exhibits, and reintroducing endangered species into the wild. Purchase the zoo
registration plate, and you immediately add your support to the efforts of the Pennsylvania Zoological Council. You’ll also
show others your love for wild animals.
For Personalized Pennsylvania zoological Council Fund registration plates, up to FIVE letters and/or numbers may be used in combination. If a hyphen or
space is used as part of the registration configuration, it counts as one of the available spaces for personalization. Only one hyphen or space is permitted, but not
both. No additional special characters are available. Please use capital letters and print clearly. When requesting a numeric character of zero, please show as "Ø"
instead of the alpha character "O." Since this is an electronically fillable form, after printing the form, please be sure any zero is marked with a "/." A pre-printed
letter configuration of “Pz” will follow your personalized configuration on your registration plate and cannot be changed.
Pennsylvania Monuments
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P
AM
Benefits the Veterans Trust Fund.
Purchase the Pennsylvania Monuments registration plate and show your support for the cleaning, repair and restoration
of Pennsylvania monuments. The registration plate pictures the Pennsylvania Memorial Monument found at the Gettysburg
National Military Park and displays the words “Gettysburg 1863.” Proceeds from the sale of this registration plate go
directly to the Veteran Trust Fund and will be used exclusively to provide grants to nonprofit organizations for the cleaning,
repair and restoration of Pennsylvania Monuments by the Gettysburg National Military Park.
For Personalized Pennsylvania Monuments registration plates, up to FIVE letters and/or numbers may be used in
combination. If a hyphen or space is used as part of the registration configuration, it counts as one of the available spaces
for personalization. Only one hyphen or space is permitted, but not both. No additional special characters are available. Please use capital letters and print
clearly. When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form, after
printing the form, please be sure any zero is marked with a "/." A pre-printed letter configuration of "gB" will follow your personalized configuration on your
registration plate and cannot be changed.
Plate Colors - Blue, white and yellow
gENEral INFOrMaTION
• Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. DO NOT sEND CasH. NOTE: NO rEFuND of the
fee will be issued when an applicant cancels a request after the order is placed.
• No Special Fund registration plate will be duplicated. If your registration plate is lost, stolen or defaced, you will need to reapply for a Special Fund
registration plate by completing this application and submitting it with the appropriate fees. Should you need an immediate replacement registration plate,
please complete Form MV-44, "Application for Duplicate Registration Card, Replacement of Registration Plate, or Weight Class Sticker," and submit the
application to PennDOT along with a fee of $11. A standard registration plate will be issued until the replacement Special Fund registration plate can be
provided.
• Requests for Special Fund registration plates are restricted to passenger cars, motor homes, trailers or trucks with a registered gross weight of not more
than 14,000 lbs. Motorcycles do not qualify for Special Fund registration plates.
• This application, completed in full, along with a check or money order, should be mailed to: Bureau of Motor Vehicles, P.O. Box 67900, Harrisburg, PA
17106-7900.
• All telephone numbers will be held in confidence and used only in the event of a problem with your application.
• Special Fund registration plates are issued in sequence, unless personalized, and may not be issued with a Persons with Disability symbol.
• To avoid possible problems with citations with your old registration plate, return it to: Bureau of Motor Vehicles, Return Tag Unit, P.O. Box 68597, Harrisburg, PA
17106-8597.
IF PERSONALIZING YOUR REGISTRATION PLATE
• PennDOT reserves the right to limit or reject certain requests.
• The fee required with the application is an additional $104, and the registration on your vehicle must be current in order for PennDOT to process your
request. The additional $104 fee covers the cost of your personalized registration plate order only and will not renew your vehicle's registration.
If your registration has expired or expires in the next three months, please include your completed renewal application, Form MV-105, "Pennsylvania
Registration Renewal Application," or Form MV-140, “Request for Registration,” and a separate check or money order in the amount of your
registration renewal fee. Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. PLEASE DO NOT SEND
CASH.
• To check personalized registration plate availability, visit PennDOT’s Driver and Vehicle Services website, www.dmv.pa.gov, and select Plate Availability
from the list of services under the Online Services heading. Personalized registration plates will not be reserved until PennDOT receives payment and a
completed application, and approves your requested registration plate configuration [number(s) and/or letter(s)]. Please note that registration plate requests
are processed on a first-come, first-served basis. Although a requested registration plate configuration may show as being available on the website, it is
possible that a request for the same registration plate configuration may have already been submitted by another customer and may not be available when
making application.
• Personalized registration plates will be manufactured on the basis of this application. NO REFUND of the fee will be issued when an applicant cancels a
request after the order is placed with the manufacturer.
• Allow eight to 10 weeks for delivery.
Visit us at www.dmv.pa.gov or call us at:
In state: 1-800-932-4600 - TDD: 1-800-228-0676 - Out-of-State: 1-717-412-5300 - TDD Out-of-State: 1-717-412-5380