Form MV117 "Sponsor Organization's Specialty License Plate Annual Certification Application" - Montana

What Is Form MV117?

This is a legal form that was released by the Montana Department of Justice - Attorney General Office - 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 March 1, 2022;
  • The latest edition provided by the Montana Department of Justice - Attorney General Office;
  • 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 fillable version of Form MV117 by clicking the link below or browse more documents and templates provided by the Montana Department of Justice - Attorney General Office.

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Download Form MV117 "Sponsor Organization's Specialty License Plate Annual Certification Application" - Montana

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Sponsor Organization’s
Specialty License Plate
Annual Certification
Application
Page 1 of 3
PLEASE PRINT P.O. Box 201431 Helena, MT 59620-1431 • Phone (406) 444-3661 • Fax (406) 444-2086•
mvdtitleinfo@mt.gov
• dojmt.gov
Organizations are required to complete an annual certification and submit supporting documentation.
Section 1: Applicant Information
Sponsor Name:
Telephone Number:
Website:
Tax ID Number:
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Section 2: Liaison Information
Printed Name of Sponsored Liaison:
Liaison Telephone Number:
Email Address:
Liaison Mailing Address:
City:
State:
Zip
Section 3: Sponsor Organization Information
1.
Is the sponsor required to register with the Montana Secretary of State (SOS)?
 Yes
 No
a. If yes, is the sponsor in good standing with SOS?
 Yes
 No
2.
Is the person listed as the liaison authorized to act as the sponsor’s liaison?
 Yes
 No
3.
Is the sponsor organization a tax-exempt organization under 26 U.S.C. 501(c)(3)
 Yes
 No
4.
Is the sponsor organization required to file annual tax filing documents, including 990N, 990EZ,
 Yes
 No
990PF, or 990? If no, why not?
5.
Is the sponsor organization of service to the community through specific programs that promote
 Yes
 No
improving health, education, or general welfare?
a
If no, is the sponsor organization comprised of military service veterans?
6.
Headquarters or base of operations:
a. Is the sponsor headquarters or base of operations in this state? If no, where is it?
 Yes
 No
b. Is the sponsor a chapter or branch of an international, national, or regional organization?
 Yes
 No
c.
If yes, is the chapter or branch in good standing and has authorization in writing from the
 Yes
 No
parent organization to use the name and graphic of the parent organization? If no, describe:
MV117 (3/22)
Montana county and state authorities reserve the right to reject any form that has been altered.
This form is available in alternate formats for people with disabilities.
Sponsor Organization’s
Specialty License Plate
Annual Certification
Application
Page 1 of 3
PLEASE PRINT P.O. Box 201431 Helena, MT 59620-1431 • Phone (406) 444-3661 • Fax (406) 444-2086•
mvdtitleinfo@mt.gov
• dojmt.gov
Organizations are required to complete an annual certification and submit supporting documentation.
Section 1: Applicant Information
Sponsor Name:
Telephone Number:
Website:
Tax ID Number:
Mailing Address:
City:
State:
Zip:
Physical Address:
City:
State:
Zip:
Section 2: Liaison Information
Printed Name of Sponsored Liaison:
Liaison Telephone Number:
Email Address:
Liaison Mailing Address:
City:
State:
Zip
Section 3: Sponsor Organization Information
1.
Is the sponsor required to register with the Montana Secretary of State (SOS)?
 Yes
 No
a. If yes, is the sponsor in good standing with SOS?
 Yes
 No
2.
Is the person listed as the liaison authorized to act as the sponsor’s liaison?
 Yes
 No
3.
Is the sponsor organization a tax-exempt organization under 26 U.S.C. 501(c)(3)
 Yes
 No
4.
Is the sponsor organization required to file annual tax filing documents, including 990N, 990EZ,
 Yes
 No
990PF, or 990? If no, why not?
5.
Is the sponsor organization of service to the community through specific programs that promote
 Yes
 No
improving health, education, or general welfare?
a
If no, is the sponsor organization comprised of military service veterans?
6.
Headquarters or base of operations:
a. Is the sponsor headquarters or base of operations in this state? If no, where is it?
 Yes
 No
b. Is the sponsor a chapter or branch of an international, national, or regional organization?
 Yes
 No
c.
If yes, is the chapter or branch in good standing and has authorization in writing from the
 Yes
 No
parent organization to use the name and graphic of the parent organization? If no, describe:
MV117 (3/22)
Montana county and state authorities reserve the right to reject any form that has been altered.
This form is available in alternate formats for people with disabilities.
Sponsor Organization’s
Specialty License Plate
Annual Certification
Application
Page 2 of 3
PLEASE PRINT P.O. Box 201431 Helena, MT 59620-1431 • Phone (406) 444-3661 • Fax (406) 444-2086•
mvdtitleinfo@mt.gov
• dojmt.gov
Section 3: Sponsor Organizations (cont.)
7.
Is this sponsor a Montana entity?
 Yes
 No
8.
Does the sponsor have an active telephone number?
 Yes
 No
9.
Are 75% of the donation fees collected for generic plates spent in Montana?
 Yes
 No
10. In the last calendar year, the sponsor collected $
a. In the last calendar year, the sponsor spent $
11. The name, identifying phrase, and graphic on the generic specialty license plate
a. Is the sponsor authorized to use them?
 Yes
 No
b. Is there any infringement or violation of any property right in the use of them?
 Yes
 No
Section 4: Required Documents Enclosed with Certification
You must enclose the following documents with your annual certification form.
Do NOT staple your documents.
 Copy of current Montana Secretary of State’s certification of good standing
 Copy of IRS determination letter
 Copy of current federal income tax filing documents
 IRS Form 990N, 990EZ, or 990PF, or 990
 Other:
 Organization is not required to submit annual tax filing documents
 List of current Board of Directors, positions, and contact information
 Additional documentations showing 75% of collected fees from Specialty License Plates were spent in Montana for the
last calendar year.
 Balance Sheet
 Profit and Loss statement
 Attach a form MV117A describing how the money collected by the Specialty License Plate was spent and detailing
whether it was spent in or outside of Montana
 Proof of Montana banking institute
 1
st
page of most recent bank statement showing sponsor name, address, date, banking institution’s name, and
account number
 Redact all financial information from this page, including balances, debits, and credits
MV117 (3/22)
Montana county and state authorities reserve the right to reject any form that has been altered.
This form is available in alternate formats for people with disabilities.
Sponsor Organization’s
Specialty License Plate
Annual Certification
Application
Page 3 of 3
PLEASE PRINT P.O. Box 201431 Helena, MT 59620-1431 • Phone (406) 444-3661 • Fax (406) 444-2086•
mvdtitleinfo@mt.gov
• dojmt.gov
Section 5: Indemnification
By signing this application, the Sponsor agrees to indemnify, hold harmless, and release DOJ/MVD and their officers,
agents, and employees from and against all loss, damages, injury, liability, suits, and proceedings arising from the use of
the name, identifying phrase, and graphic on the generic specialty license plate, including but not limited to any loss,
damages, injury, liability, suits, or proceedings from the use of the name, identifying phrase, and graphic.
Section 6: Certification
I understand and accept § 61-3-472 through § 61-3-481, MCA Specialty License Plate requirements.
I have reviewed my organization’s information as listed on the Motor Vehicle Division’s website
https://dojmt.gov/driving/plate-designs-and-fees/
and no updates are needed at this time. If updates are needed,
submit form MV115 or MV116 as applicable.
Under penalty of law (§ 45-7-203, MCA), I certify that:
o The statements made and information contained on this form, the attached form, and banking statements are true
and correct to the best of my knowledge, information, and belief;
o I am the person named on this form; and
o If signing for a business entity or trust, I have full authority to do so.
Dated this
Day of
, 20
Printed name
Legal signature
Section 7: Department Use Only
 The application for sponsorship is approved
 The application for sponsorship is rejected for the following reasons:
Specialty Plate Coordinator Signature:
Date:
MV117 (3/22)
Montana county and state authorities reserve the right to reject any form that has been altered.
This form is available in alternate formats for people with disabilities.
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