Form Vr-124 - Application/certification For Organizational License Plates
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1Motor Vehicle Administration
VR-124 (11-12)
6601 Ritchie Highway, N.E.
Glen Burnie, Maryland 21062
Application/Certification for Organizational License Plates
Instructions: Please complete the entire application (owner and/or co-owner). Submit appropriate fees with application.
Name of Organization:
I certify that the individual below is a bona fide member of the above organization:
Signature of Authorized Representative
Owner’s Name, First
Middle
Last
Driver’s License Number
Street Address
City
County
State
Zip Code
Co-Owner’s Name, First
Middle
Last
Driver’s License Number
I hereby authorize the representative of my organization to review/release my personal information for official purposes:
Owner’s Signature
Co-Owner’s Signature
Vehicle Information
Year
Make
Sticker No.
Title No.
Tag No.
Vehicle Identification Number
Insurance Co.
Policy/Binder No.
❑
❑
Organizational Member: (Check one)
Owner
Co-Owner
❑
❑
❑
❑
Check Class:
Passenger Car
Multi-purpose vehicle
Truck 1 ton or less
Motorcycle
Fees: Non Logo Organizational Tags: $15.00
Logo: $25.00
I certify, under penalty of perjury, that the above information is true and correct to the best of my knowledge:
Signature of Owner
Date
Signature of Co-Owner
Date
❑
❑
❑
❑
MVA Use Only:
New Issue
Substitute
Surviving Spouse
S/N
❑
❑
Gratis
Paid
Approved by:
Tag Issued:
You may either mail your application and the appropriate fees to:
Motor Vehicle Administration, Vehicle Registration Organizational Unit; 6601 Ritchie Highway, Glen Burnie, MD 21062;
or visit the MVA full Service Office in Glen Burnie and have your plates issued to you.
Original - MVA
Copy - Customer
For more information, please call: 410-768-7000 (to speak with a customer service representative).
TTY for the hearing impaired: 1-800-492-4575. Visit our website at:
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