BMV FORM NO. 2023-8-25-2|REV. Sep-08-2023 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES BUREAU OF MOTOR VEHICLES VANITY LICENSE PLATE DISTRIBUTOR APPLICATION/RENEWAL BMV STX - Patrick Sweeny Headquarters RR-01 Box 10065 St. Croix, V.I. 00850-9705 Tel: (340) 713-4268 BMV STT 4605 Tutu Park Mall - Suite 231 St. Thomas, V.I. 00802-1736 Tel: (340) 774-4268 BMV STJ – Government Complex Cruz Bay St. John, V.I. 00831 Tel: (340) 776-6262 NOTICE: ORGANIZATIONS MUST SUBMIT A RENEWAL APPLICATION EVERY YEAR WITH AN UPDATED LIST OF ISSUED PLATES/OWNERS. ORGANIZATION INFO ORGANIZATION NAME TRADE NAME PHYSICAL ADDRESS ADDRESS CITY & ISLAND ZIP CODE MAILING ADDRESS ADDRESS | PO BOX CITY & ISLAND ZIP CODE CONTACT INFO. EMAIL ADDRESS PHONE NUMBER (S) NAME OF REPRESENTATIVE FIRST NAME MIDDLE NAME LAST NAME CONTACT INFO. EMAIL ADDRESS PHONE NUMBER (S) REQUIRED DOCUMENTS NEW APPLICATION DOCUMENTS • Articles of Incorporation • Official Request Letter • Completed Application • Application Fee RENEWAL APPLICATION DOCUMENTS • Articles of Incorporation • Completed Application • Updated List of Issued Plates/Recipient Page 1 of 2 BMV FORM NO. 2023-8-25-2|REV. Sep-08-2023 GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES BUREAU OF MOTOR VEHICLES VANITY LICENSE PLATE DISTRIBUTION REPORT NO. OF PLATES REQUESTED NO. OF PLATES RECEIVED NO. PLATE(S) ISSUED PLATE DISTRIBUTION DETAILS PLATE NUMBER CUSTOMER ISSUED TO PLATE STATUS TO BE REGISTERED REGISTERED DO NOT WRITE BELOW DO NOT WRITE BELOW BMV CERTIFICATE DATE ____________________________ _____________________________ Authorized Signature Date Page 2 of 2