Form SFN 52908 Application for North Dakota Firefighter's Plate - North Dakota

Form SFN52908 or the "Application For North Dakota Firefighter's Plate" is a form issued by the North Dakota Department of Transportation.

Download a PDF version of the Form SFN52908 down below or find it on the North Dakota Department of Transportation Forms website.

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APPLICATION FOR NORTH DAKOTA
MOTOR VEHICLE DIVISION
ND DEPT OF TRANSPORTATION
FIREFIGHTER'S PLATE
608 E BOULEVARD AVE
North Dakota Department of Transportation, Motor Vehicle
BISMARCK ND 58505-0780
Telephone (701) 328-2725
SFN 52908 (12-2018)
Website: https://dot.nd.gov
APPLICANT
Applicant's Legal name
Telephone Number
Mailing Address
City
State
ZIP Code
Year and Make of Vehicle
License Number
Title Number
North Dakota law allows firefighters who are members of a city, rural, or fire protection district in good standing with the North
Dakota Firefighter's Association to obtain special license plates. There is an annual fee of $15 in addition to the regular license
fee. Qualified applicants must complete the information above and have their application certified by their Fire Chief and the
Executive Director of the North Dakota Firefighter's Association before submitting this application.
If a qualified applicant requests a personalized plate, the annual fee is $40 ($15 firefighter fee + $25 personalized plate fee) in
addition to the regular license fee. Maximum number of characters is five (5).
PLEASE MAKE SURE ALL LETTERS ARE CAPITALIZED AND NUMBERS ARE WRITTEN CLEARLY
First Choice:
Second Choice:
Meaning of Plate (Required for new and reorders)
Meaning of Plate (Required for new and reorders)
Applicant's Legal Signature
Date
FIRE DEPARTMENT
Fire Chief
Department (City, Rural, or Fire Protection District)
I certify the information above is correct and that the named applicant is a firefighter, a member in good standing within my
organization, and is eligible for the North Dakota Firefighter's License Plate.
Signature of Fire Chief
Date
NORTH DAKOTA FIREFIGHTER'S ASSOCIATION
Printed Name of Authorized Individual of the North Dakota Firefighter's Association
I certify that the above named fire chief of the said fire department is a member of the North Dakota Firefighter's Association in
good standing and is approved to certify the eligibility of the firefighter making application for the firefighter's license plate.
Signature of Authorized Individual
Date
APPLICATION FOR NORTH DAKOTA
MOTOR VEHICLE DIVISION
ND DEPT OF TRANSPORTATION
FIREFIGHTER'S PLATE
608 E BOULEVARD AVE
North Dakota Department of Transportation, Motor Vehicle
BISMARCK ND 58505-0780
Telephone (701) 328-2725
SFN 52908 (12-2018)
Website: https://dot.nd.gov
APPLICANT
Applicant's Legal name
Telephone Number
Mailing Address
City
State
ZIP Code
Year and Make of Vehicle
License Number
Title Number
North Dakota law allows firefighters who are members of a city, rural, or fire protection district in good standing with the North
Dakota Firefighter's Association to obtain special license plates. There is an annual fee of $15 in addition to the regular license
fee. Qualified applicants must complete the information above and have their application certified by their Fire Chief and the
Executive Director of the North Dakota Firefighter's Association before submitting this application.
If a qualified applicant requests a personalized plate, the annual fee is $40 ($15 firefighter fee + $25 personalized plate fee) in
addition to the regular license fee. Maximum number of characters is five (5).
PLEASE MAKE SURE ALL LETTERS ARE CAPITALIZED AND NUMBERS ARE WRITTEN CLEARLY
First Choice:
Second Choice:
Meaning of Plate (Required for new and reorders)
Meaning of Plate (Required for new and reorders)
Applicant's Legal Signature
Date
FIRE DEPARTMENT
Fire Chief
Department (City, Rural, or Fire Protection District)
I certify the information above is correct and that the named applicant is a firefighter, a member in good standing within my
organization, and is eligible for the North Dakota Firefighter's License Plate.
Signature of Fire Chief
Date
NORTH DAKOTA FIREFIGHTER'S ASSOCIATION
Printed Name of Authorized Individual of the North Dakota Firefighter's Association
I certify that the above named fire chief of the said fire department is a member of the North Dakota Firefighter's Association in
good standing and is approved to certify the eligibility of the firefighter making application for the firefighter's license plate.
Signature of Authorized Individual
Date

Download Form SFN 52908 Application for North Dakota Firefighter's Plate - North Dakota

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