MVR-35

MVR-35 (Rev. 9/17)

North Carolina Division of Motor Vehicles 3155 Mail Service Center Raleigh, North Carolina 27697-3155

Do not write in this space

APPLICATION FOR A SPECIAL AMATEUR RADIO REGISTRATION PLATE (Remit a $10.00 check or money order with this application.)

Name

____________________________________________________________

Home Phone __________________________

Work Phone _________________________

(THE CALL LETTERS AND CERTIFICATE OF TITLE MUST AGREE IN NAME)

Address ______________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________ (CITY)

(STATE)

(ZIP CODE)

(COUNTY)

I, the undersigned, do hereby certify that I hold an unrevoked and unexpired amateur radio license, of a renewable nature, issued by the Federal Communications Commission, and, that I have purchased a portable radio unit suitable for use in emergencies.

My call letters are: ____________________________

Current plate number ____________________________________

Make ________________________________________

Body style __________________________

Title number ____________________________________

Vehicle identification number ________________________________________________________

Year Model _____________________________________

Signature of owner __________________________________________________________________

Date ____________________________________________

* Only for second or subsequent plate with same call letters.

Suffix * desired ____________________________