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This is a New Jersey form that can be used for Motor Vehicle Commission within Statewide.
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New Jersey Motor Vehicle Commission Application for Historic (QQ) Plates FOR MVC USE: Plate No: ____________ Date Issued: __________ Brief Description & Eligibility - Historic registration may be assigned to an antique vehicle which is at least twentyfive (25) years old. The vehicle must be owned as a collector's item and used solely for exhibition or educational purposes. Please note that the vehicle cannot be altered from the manufacturer's original design in any way and must be equipped for legal operation on New Jersey roadways. Historic registration must be renewed every three (3) years, but there will be nofee for the renewal. The vehicle must be covered by the minimum automobile insurance coverage required by the State of New Jersey. current New Jersey title issued in your name. 2) Two color photographs of the vehicle, front and side view. 3) Pay required fee as follows: $44.00 Standard Historic Plates, $74.00 - Courtesy Historic Plates, $94.00 Personalized Historic Plates. Last Name Street Address NJ Driver License No. City Date of Birth First Name State Middle Initial Zip Requirements - Please r eturn your f ully c ompleted a pplication with t he f ollowing documents: 1) A p hotocopy of t he Owner Daytime Telephone Number Is your registration privilege now revoked or suspended in any state? - Yes Vehicle Identification Number Body Type Model Policy Number - No Weight Class Color Vehicle Year Insurance Company Make If you would like Courtesy Historic Plates or Personalized Historic Plates, clearly list three choices. First Choice: _______________________ Second Choice: ___________________________ Third Choice: ____________________________ I, the applicant, hereby certify that the vehicle described above will be solely used for exhibition and educational purposes and that the statements on this application are correct. A person who makes a misstatement of fact on an app lication for registration, is subject, upon conviction, to a fine of not more than $500 and/or imprisonment for not more than six months, or both, at the discretion of the c ourt. A pplicant i s also subject t o suspension of r egistration p rivileges f or a per iod of not more than two years. N.J.S.A. 39:3-37. X________________________________________________________________________/_______________________ Owner Signature Name: ______________________________________________ Street: ______________________________________________ City: State: Zip: ______________________________________________ SP-121 (R1/10) Date DO NOT cut along the dotted line. If you have any questions regarding Historic, Personalized Historic, Courtesy Historic, or any other type of Specialty Plate please contact the MVC toll-free at 888-486-3339 ext. 5061 or visit our website at www.njmvc.gov. Please note that Personalized, Courtesy, and Motorcycle Historic Plates MUST be issued through the mail at the following address: NJ MVC, Special Plate Unit, 225 E. State Street, P.O. Box 015, Trenton, NJ, 08666. Thank you for applying for Historic Vehicle Registration through the State of New Jersey, Motor Vehicle Commission. American LegalNet, Inc. www.FormsWorkFlow.com