Form BMV4816 "Application for Senior, Temporary Farm and Camp Bus License Plates" - Ohio

What Is Form BMV4816?

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

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Ohio Department of Public Safety;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form BMV4816 by clicking the link below or browse more documents and templates provided by the Ohio Department of Public Safety.

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Download Form BMV4816 "Application for Senior, Temporary Farm and Camp Bus License Plates" - Ohio

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OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
APPLICATION FOR SENIOR, TEMPORARY FARM
AND CAMP BUS LICENSE PLATES
You MUST CHECK THE TYPE of new plate requested or your application cannot be processed.
SENIORS BUS
TEMPORARY FARM BUS
CAMP BUS
TYPE OR PRINT
INSTRUCTIONS ON BACK
REGISTRATION INFORMATION FOUND ON OHIO REGISTRATION CARD
OHIO LICENSE PLATE #
EXPIRATION DATE
VEHICLE INFORMATION FROM OHIO CERTIFICATE/MEMORANDUM TITLE
DATE VEH PURCHASED
VEH YEAR
VEH MAKE
VEH TYPE
VEH COLOR
VEH SERIAL #
CERTIFICATE OF TITLE #
# OF PLATES REQUESTED
1
2
OWNER INFORMATION
OWNER NAME
DAYTIME PHONE #
TIN
OHIO ADDRESS
CITY
STATE
ZIP CODE
OH
E-MAIL ADDRESS
VEHICLE OWNERSHIP
JOINT OWNER / LESSEE NAME
SSN OR TAX ID #
OHIO COUNTY OF RESIDENCE
SINGLE
JOINT
LEASED
COMPANY
OWNER BUSINESS ADDRESS
CITY
STATE
ZIP CODE
Is your license plate registration under suspension or revocation under Ohio Financial Responsibility Law?
YES
NO
IF PLATE(S) ARE TO BE MAILED TO A DIFFERENT ADDRESS FROM THAT SHOWN ABOVE, FILL IN THE FOLLOWING
ADDRESS
CITY
STATE
ZIP CODE
PROOF OF FINANCIAL RESPONSIBILITY
YOU WILL LOSE YOUR DRIVER LICENSE IF YOU DRIVE WITHOUT INSURANCE OR OTHER FR PROOF
In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage.
It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage.
PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket At all vehicle inspection stops Upon traffic court appearances.
ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license until requirements are met on
first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration  Pay reinstatement fees of
$100.00 for first offense, $300.00 for second offense, $600.00 for third and subsequent offenses Pay a $50.00 penalty for any failure to surrender his or her driver license,
license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for
THREE or FIVE YEARS.
ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated
for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to
register any motor vehicle in Ohio for FIVE YEARS.
IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A
SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied).
THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW.
WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR
OTHER FR COVERAGE.
WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: AN INSURANCE POLICY showing automobile liability insurance of at
least $25,000 bodily injury per person, $50,000 injury two or more persons, and $25,000 property damage AN INSURANCE IDENTIFICATION CARD (same coverage) A
SURETY BOND OF $30,000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least
$60,000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE
OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles.
I affirm that the owners (or lessees of leased vehicle) now have insurance or other proof of financial responsibility (FR Proof)
covering this vehicle and will not operate or permit the operation of this vehicle without FR Proof; and will not be used as a
commercial vehicle unless so registered.
APPLICANT SIGNATURE
DATE
X
WARNING:
Applicant giving false information is subject to prosecution Ohio Revised Code (R.C.) 2913.42
Application must be signed by the owner(s) as named on Certificate of Title.
CERTIFICATE OF TITLE AND/OR EPA INSPECTED BY:
DEPUTY REGISTRAR NAME/NUMBER
Your application will be processed and new plate(s) mailed within four weeks. Failure to follow instructions will delay the
issuance of your license plate(s).
NOTE: YOU MUST HAVE YOUR VEHICLE INSPECTED ANNUALLY BY THE HIGHWAY PATROL IF YOUR VEHICLE IS
MANUFACTURED TO TRANSPORT MORE THAN FIFTEEN (15) PASSENGERS, INCLUDING THE DRIVER, OR HAS A GROSS
VEHICLE WEIGHT THAT EXCEEDS TEN THOUSAND POUNDS.
PUBLIC
BMV 4816 7/20 [760-1067] Page 1 of 2
OHIO DEPARTMENT OF PUBLIC SAFETY
BUREAU OF MOTOR VEHICLES
APPLICATION FOR SENIOR, TEMPORARY FARM
AND CAMP BUS LICENSE PLATES
You MUST CHECK THE TYPE of new plate requested or your application cannot be processed.
SENIORS BUS
TEMPORARY FARM BUS
CAMP BUS
TYPE OR PRINT
INSTRUCTIONS ON BACK
REGISTRATION INFORMATION FOUND ON OHIO REGISTRATION CARD
OHIO LICENSE PLATE #
EXPIRATION DATE
VEHICLE INFORMATION FROM OHIO CERTIFICATE/MEMORANDUM TITLE
DATE VEH PURCHASED
VEH YEAR
VEH MAKE
VEH TYPE
VEH COLOR
VEH SERIAL #
CERTIFICATE OF TITLE #
# OF PLATES REQUESTED
1
2
OWNER INFORMATION
OWNER NAME
DAYTIME PHONE #
TIN
OHIO ADDRESS
CITY
STATE
ZIP CODE
OH
E-MAIL ADDRESS
VEHICLE OWNERSHIP
JOINT OWNER / LESSEE NAME
SSN OR TAX ID #
OHIO COUNTY OF RESIDENCE
SINGLE
JOINT
LEASED
COMPANY
OWNER BUSINESS ADDRESS
CITY
STATE
ZIP CODE
Is your license plate registration under suspension or revocation under Ohio Financial Responsibility Law?
YES
NO
IF PLATE(S) ARE TO BE MAILED TO A DIFFERENT ADDRESS FROM THAT SHOWN ABOVE, FILL IN THE FOLLOWING
ADDRESS
CITY
STATE
ZIP CODE
PROOF OF FINANCIAL RESPONSIBILITY
YOU WILL LOSE YOUR DRIVER LICENSE IF YOU DRIVE WITHOUT INSURANCE OR OTHER FR PROOF
In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage.
It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage.
PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket At all vehicle inspection stops Upon traffic court appearances.
ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license until requirements are met on
first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration  Pay reinstatement fees of
$100.00 for first offense, $300.00 for second offense, $600.00 for third and subsequent offenses Pay a $50.00 penalty for any failure to surrender his or her driver license,
license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for
THREE or FIVE YEARS.
ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated
for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to
register any motor vehicle in Ohio for FIVE YEARS.
IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A
SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied).
THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW.
WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR
OTHER FR COVERAGE.
WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: AN INSURANCE POLICY showing automobile liability insurance of at
least $25,000 bodily injury per person, $50,000 injury two or more persons, and $25,000 property damage AN INSURANCE IDENTIFICATION CARD (same coverage) A
SURETY BOND OF $30,000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least
$60,000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE
OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles.
I affirm that the owners (or lessees of leased vehicle) now have insurance or other proof of financial responsibility (FR Proof)
covering this vehicle and will not operate or permit the operation of this vehicle without FR Proof; and will not be used as a
commercial vehicle unless so registered.
APPLICANT SIGNATURE
DATE
X
WARNING:
Applicant giving false information is subject to prosecution Ohio Revised Code (R.C.) 2913.42
Application must be signed by the owner(s) as named on Certificate of Title.
CERTIFICATE OF TITLE AND/OR EPA INSPECTED BY:
DEPUTY REGISTRAR NAME/NUMBER
Your application will be processed and new plate(s) mailed within four weeks. Failure to follow instructions will delay the
issuance of your license plate(s).
NOTE: YOU MUST HAVE YOUR VEHICLE INSPECTED ANNUALLY BY THE HIGHWAY PATROL IF YOUR VEHICLE IS
MANUFACTURED TO TRANSPORT MORE THAN FIFTEEN (15) PASSENGERS, INCLUDING THE DRIVER, OR HAS A GROSS
VEHICLE WEIGHT THAT EXCEEDS TEN THOUSAND POUNDS.
PUBLIC
BMV 4816 7/20 [760-1067] Page 1 of 2
INSTRUCTIONS
SENIOR BUS (R.C. 4503.04)
Below affidavit must be completed.
The owner of a bus used principally for the transportation of persons sixty-five years of age or older may obtain Seniors
license plate(s). To qualify for Seniors bus license plate(s), the bus must seat 10 or more.
TEMPORARY FARM BUS (R.C. 4503.04)
Below affidavit must be completed.
Temporary farm bus vehicle license plate(s) can be issued for a period of two hundred ten days from the date of issue of
the license plate(s) for the bus, for a fee of ten dollars, provided such license plate(s) shall not be issued for more than any
one such period in any calendar year. The bus will be used solely for the transportation of agricultural employees, and used
only in transportation of such employees as are needed in the operation of the farm. Statement must be completed and
signed by the owner(s) or lessee(s).
CAMP BUS (R.C. 4503.17)
Below statement and affidavit must be completed.
The owner of a school bus under contract with a board of education may use such bus during summer vacation periods to
transport children and their authorized supervisors to and from any camping function sponsored by a nonprofit, tax-exempt,
charitable, or philanthropic organization. Certificate for school bus from State Highway Patrol required.
STATEMENT
OWNER OF BUS OR NAME OF SCHOOL BOARD
STREET ADDRESS
CITY
COUNTY
MAKE OF BUS
YEAR
SERIAL #
(CAMP BUS) Name:
is under contract with this school board of education to
transport school children either to and from school, or to and from any school function.
SIGNATURE
NAME OF SCHOOL BOARD OF EDUCATION (CAMP BUS)
DATE
X
AFFIDAVIT MUST BE NOTARIZED
OWNER OF BUS
STREET ADDRESS
CITY
YEAR/MAKE
SERIAL #
SCHOOL BUS LIC #: (CAMP BUS)
NAME OF LESSEE
STREET ADDRESS
CITY
Applicant being first duly sworn states that the bus described above has a seating capacity of ten or more and
(Check one)
Will be used principally for the transportation of persons sixty-five years of age or older.
Will be operated exclusively during the summer months to transport children and their authorized supervisors to and
from any camping function sponsored by a nonprofit, tax-exempt, charitable or philanthropic organization.
Will be used solely for the transportation of agricultural employees, and used only in the transportation of such
employees as are necessary in the operation of the farm, for a two hundred ten day period, beginning with the effective
date of Temporary Farm Bus registration.
SIGNATURE OF OWNER(S) OR LESSEE(S)
DATE
X
Notary:
Sworn to and subscribed in my presence this
day of
, 20
in
County,
State of
.
(Notary Seal)
Signature of Notary Public X
My commission expires
THE FOLLOWING ITEMS MUST BE RETURNED TO THE OHIO BMV TO REGISTER BY MAIL:
1.
Total amount due. Make check or money order payable to: Ohio Treasurer of State, BMV, Add permissive tax to total due if
applicable.
2.
The R.C. 4503.19 requires that you ADD $7.50 for two (2) plates or $6.25 for one (1) plate to the above fees for replacement plate(s)
if your vehicle is currently registered or has been registered within the last 12 months.
3.
Current OHIO vehicle registration card for above vehicle. Temporary tag registration or registration card which expired more than 11
months ago is unacceptable. If registration card is unavailable, send Certificate of Title or Memorandum Title (original document only).
You may take these documents to any deputy registrar agency. The deputy will verify the vehicle information for a service fee.
4.
Required documents as stated ABOVE (see instructions) for the type of registration being requested.
5.
Affidavit and/or statement must be completed.
6.
Completed and signed application. Mailing address on front.
7.
If leased provide a copy of lease agreement.
You are now permitted to donate $1.00 to the children’s Save Our Sight Program by checking the appropriate box below and adding an
additional $1.00 to your total fees due. For more information on the children’s Save Our Sight Program, please call 1-800-755-GROW (4769).
Yes, I would like to donate to the children’s Save Our Sight Program. I have added $1.00 to the total fees due.
OHIO BUREAU OF MOTOR VEHICLES, ATTN: REGISTRATION SUPPORT SERVICES
P.O. Box 16521, Columbus, Ohio 43216-6521, (614) 752-7518
PUBLIC
BMV 4816 7/20 [760-1067] Page 2 of 2
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