STATE OF RHODE ISLAND
DIVISION OF MOTOR VEHICLES
Plate Office
600 New London Avenue
Cranston, RI 02920-3024
DMV.PlateOffice@dmv.ri.gov
www.dmv.ri.gov
Save a stamp and time, and order your charity design online at www.ri.gov/DMV/plate_remake/
APPLICATION FOR CHARITY LICENSE PLATES
NOTE: You must include a current copy of your registration when applying for a charity plate.
PLATE OWNER (Please print true full name of current plate owner) * ALL INFORMATION BELOW IS REQUIRED*
LAST NAME (or Business Name) FIRST NAME DL/CDL/ID NUMBER
MAILING ADDRESS CITY STATE ZIP CODE
E-MAIL ADDRESS TELEPHONE
( )
CURRENT ACTIVE PLATE NUMBER CURRENT PLATE DESIGN: (Ocean, Sailboat, etc)
PLATE TYPE (passenger, combination, commercial)
Please include check or money order made out to RIDMV for $42.50 for initial order or $32.50 for a remake.
Mail all to the DMV address above. Please check one box & circle one plate type (if choice is offered).
Plate design will be:
Atlantic Shark Institute (Passenger, Commercial or Combination)
Audubon Society of RI/Save the Bay (Passenger: Maximum 5 characters)
Beavertail Lighthouse Museum Association (Passenger)
Boston Bruins Foundation (Passenger)
Bristol Fourth of July Committee (Passenger)
Friends of the Plum Beach Lighthouse (Passenger: Maximum 5 characters)
Gaspee Days Committee (Passenger)
Gloria Gemma Breast Cancer Resource Foundation (Passenger)
New England Patriots Charitable Foundation (Passenger or Commercial: Maximum 5 characters)
Pomham Rocks Lighthouse (Passenger)
Providence College (Passenger)
Red Sox Foundation (Passenger or Commercial: Maximum 5 characters)
RI Community Food Bank (Passenger: Maximum 5 characters)
Rocky Point Foundation (Passenger)
Rose Island Lighthouse (Passenger)
Wildlife Rehabilitators Association of RI (Passenger)
CONTINUED ON THE BACK
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I WOULD LIKE TO PURCHASE THE FOLLOWING CHARITY PLATE:
WHEN YOUR NEW CHARITY PLATES ARE READY:
The DMV will mail them to you, along with a new registration certificate and new registration stickers, at your
address indicated above. Please destroy or recycle your old plates.
DO NOT RETURN THEM TO ANY DMV OR AAA OFFICE.
Returning your old plates may result in the cancellation of your registration.
SIGNATURE REQUIRED FROM ALL APPLICANTS
By completing and submitting this form, applicant consents to the Rhode Island Division of
Motor Vehicles sharing the information provided with the charitable organization selected.
Such information includes, but is not limited to, the applicant’s name, address, telephone
number, and/or email address.
I certify (or declare) under penalty of perjury under laws of Rhode Island, that the foregoing is true and correct.
SIGNATURE
DATE (mm/dd/yyyy)
rev. 7/7/2023
