Form MV116 "Governmental Body Application to Sponsor a Specialty License Plate" - Montana

What Is Form MV116?

This is a legal form that was released by the Montana Department of Justice - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the Montana Department of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form MV116 by clicking the link below or browse more documents and templates provided by the Montana Department of Justice.

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Download Form MV116 "Governmental Body Application to Sponsor a Specialty License Plate" - Montana

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Governmental Body
Application to Sponsor a
Specialty License Plate
Fee: $4,120
(fee includes 3% administration fee per
MCA
61-3-111
make check payable to Montana Correctional Enterprises)
P.O. Box 201431 Helena, MT 59620-1431  Fax (406) 444-2086  Email
mvdtitleinfo@mt.gov
www.dojmt.gov/driving
Complete this application and submit it to the above address.
Applicant Section
Name of governmental body:
Physical address (required):
City:
State:
Zip:
Mailing address (if different from above):
City:
State:
Zip:
Tax ID Number:
Website address:
Phone Number:
If a state agency:
Identify the statutory authority under which you seek sponsorship of these plates:
______
Specify the account in which plate donations will be placed:
The required donation as determined by the sponsor is $
Once license plate design is approved and released, donations may be received electronically by
sending an email to dojmvdfiscal@mt.gov Liaison Section
Name of governmental body’s specialty license plate liaison
Email address:
Telephone number:
(please print):
Mailing address:
City:
State:
Zip:
Plate Purpose Section
To help educate potential donors, provide a brief summary of how your organization will use
the funds collected from your plate. Limit your description to 50 words or less. This
information will be posted with your plate on the Motor Vehicle Division website.
Example: This plate benefits organizations that create or support autism awareness programs. This plate generates funds
for research, public awareness and education programs, scholarship programs, and to provide support for caregivers for
individuals with autism.
jghfghfghjf
MV116 (10/19)
Governmental Body
Application to Sponsor a
Specialty License Plate
Fee: $4,120
(fee includes 3% administration fee per
MCA
61-3-111
make check payable to Montana Correctional Enterprises)
P.O. Box 201431 Helena, MT 59620-1431  Fax (406) 444-2086  Email
mvdtitleinfo@mt.gov
www.dojmt.gov/driving
Complete this application and submit it to the above address.
Applicant Section
Name of governmental body:
Physical address (required):
City:
State:
Zip:
Mailing address (if different from above):
City:
State:
Zip:
Tax ID Number:
Website address:
Phone Number:
If a state agency:
Identify the statutory authority under which you seek sponsorship of these plates:
______
Specify the account in which plate donations will be placed:
The required donation as determined by the sponsor is $
Once license plate design is approved and released, donations may be received electronically by
sending an email to dojmvdfiscal@mt.gov Liaison Section
Name of governmental body’s specialty license plate liaison
Email address:
Telephone number:
(please print):
Mailing address:
City:
State:
Zip:
Plate Purpose Section
To help educate potential donors, provide a brief summary of how your organization will use
the funds collected from your plate. Limit your description to 50 words or less. This
information will be posted with your plate on the Motor Vehicle Division website.
Example: This plate benefits organizations that create or support autism awareness programs. This plate generates funds
for research, public awareness and education programs, scholarship programs, and to provide support for caregivers for
individuals with autism.
jghfghfghjf
MV116 (10/19)
Certification Section:
I understand and accept MCA 61-3-472 through 61-3- 481 sponsor plate requirements.
Under penalty of law (MCA 45-7-203), I certify that the statements made and information
contained on this form are true and correct to the best of my knowledge, information, and
belief; I am the person named on this form; and, if signing for a business entity or trust, I
have full authority to do so.
Dated this
day of
, 20
This is My Legal Signature
Printed Name
Department use only:
The application for sponsorship is approved.
The application for sponsorship is rejected for the following reasons:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
MVD Liaison Signature:
Date:
jghfghfghjf
MV116 (10/19)
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