Application for FIU License Plate

Owner's Name Owner's Name * First Last
Email *
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Previous License Plate Number *
Confirmation

I hereby certify under the penalty of perjury that the license plate, decal or permit for the vehicle listed in Section 3(a), is no longer or has never been in my possession for the reason checked in Section 1. All information herein is true and correct to the best of my knowledge.
Draw your signature into the box below. *

Clear