This form contains 82 fields organized into 24 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Application Type
Original	Checkbox	Check this box if you are applying for an original special interest license plate.
Conversion	Checkbox	Check this box if you are converting an existing license plate to a special interest license plate.
Replacement	Checkbox	Check this box if you are replacing a lost, stolen, or damaged special interest license plate.
Reassign, Retain, Release	Checkbox	Check this box if you are reassigning your special interest license plate to another vehicle, retaining it for future use, or releasing it.
Auto Club Pickup Location
Auto Club Location	Checkbox	Check this box if you are an Auto Club member and wish to pick up your plates at an Auto Club location.
Auto Club Location	Text	Please enter the Auto Club location where you will pick up the plates. This option is for Auto Club members only.
Center Configuration
Plate Configuration	Text	Provide the desired characters and spacing for your special interest license plate, following the instructions for 1/2 space (/) and full space (*).
Daytime Phone Number
enter daytime area code	Text	Max length: 3 characters
Daytime Phone Number	Text	Enter the daytime phone number, including the area code. Max length: 7 characters
DMV Office Pickup Location
DMV Office Pickup Location	Checkbox	Check this box if you wish to pick up your plates at a DMV Office.
DMV Office Pickup Location	Text	Enter the specific location of the DMV office where the plates will be picked up.
First Plate Choice
First Plate Choice	Text	Enter the desired combination of letters, numbers, and spacing symbols for your first plate choice. Max length: 7 characters
General
Enter first choice, first letter or character	Text	Max length: 1 characters
enter second letter or character	Text	Max length: 1 characters
enter third letter or character	Text	Max length: 1 characters
enter fourth letter or character	Text	Max length: 1 characters
enter fifth letter or character	Text	Max length: 1 characters
enter sixth letter or character	Text	Max length: 1 characters
enter seventh letter or character	Text	Max length: 1 characters
second choice. enter first lettor or character	Text	Max length: 1 characters
enter second letter or character	Text	Max length: 1 characters
enter third letter or character	Text	Max length: 1 characters
enter fourth letter or character	Text	Max length: 1 characters
enter fifth letter or character	Text	Max length: 1 characters
enter sixth letter or character	Text	Max length: 1 characters
enter seventh letter or character	Text	Max length: 1 characters
third choice. enter first letter or character	Text	Max length: 1 characters
enter second letter or character	Text	Max length: 1 characters
click to print	Button
click to clear form	Button
Gift Recipient Name
Gift Recipient Last Name	Text	Please enter the last name of the gift recipient.
Gift Recipient First Name	Text	Please enter the first name of the gift recipient.
Gift Recipient Middle Name	Text	Please enter the middle name of the gift recipient.
Mailing Address
Enter plate owner mailing address, street or p o box	Text
City	Text	Provide the city for the mailing address.
State	Text	Provide the state for the mailing address. Max length: 2 characters
Zip Code	Text	Provide the zip code for the mailing address.
Meaning for First Choice
First Choice Meaning	Text	Provide the meaning or explanation for your first requested plate choice.
Meaning for Second Choice
Second Choice Meaning	Text	Enter the meaning for your second choice of special interest license plate.
Meaning for Third Choice
Third Choice Meaning	Text	Provide the meaning for the third requested plate choice.
Number of Plates Needed
One Plate	Checkbox	Check this box if you need one replacement plate.
Two Plates	Checkbox	Check this box if you need two replacement plates.
Personalization Choice
Personalized	Checkbox	Check this box if you want to order a personalized license plate.
Non-Personalized	Checkbox	Check this box if you want a non-personalized license plate and will submit your current registration card to receive the next available plate in series.
Plate Action
Retain for future use	Checkbox	Check this box if you wish to retain your plate for future use, acknowledging that an annual fee is required.
Fee enclosed	Checkbox	Check this box to indicate that the required fee for retaining the plate for future use is enclosed.
Release Interest	Checkbox	Check this box if you wish to release your interest in the personalized plate.
Plate Centering Option
Do Not Center Plate	Checkbox	Check this box if you do not want the plate configuration to be centered.
Plate Owner Information
Plate Number	Text	Enter the license plate number. Max length: 7 characters
Plate Owner Last Name	Text	Provide the last name of the plate owner or purchaser.
Plate Owner First Name	Text	Provide the first name of the plate owner or purchaser.
Plate Owner Middle Name	Text	Provide the middle name of the plate owner or purchaser.
Plate Transfer Information
Special Interest License Plate Number	Text	Enter the special interest license plate number. Max length: 7 characters
Removed From Vehicle Identification Number	Text	Enter the Vehicle Identification Number (VIN) of the vehicle from which the plate was removed. Max length: 17 characters
Placed On Current License Plate	Text	Enter the current license plate number if the special interest plate is being placed on it. Max length: 7 characters
Placed On Vehicle Identification Number	Text	Enter the Vehicle Identification Number (VIN) of the vehicle where the special interest plate is being placed. Max length: 17 characters
Plate Type
Environmental License Plate (ELP)	Checkbox	Check this box if you are applying for an Environmental License Plate (ELP).
Arts	Checkbox	Check this box if you are applying for an Arts license plate.
California Agricultural (CalAg)	Checkbox	Check this box if you are applying for a California Agricultural (CalAg) license plate.
CA Firefighter	Checkbox	Check this box if you are applying for a CA Firefighter license plate; documentation is required.
California Memorial	Checkbox	Check this box if you are applying for a California Memorial license plate.
Coastal Commission (Whale Tail)	Checkbox	Check this box if you are applying for a Coastal Commission (Whale Tail) license plate.
Collegiate (only UCLA available)	Checkbox	Check this box if you are applying for a Collegiate license plate, currently only available for UCLA.
Kids	Checkbox	Check this box if you are applying for a Kids license plate; a symbol must be circled as indicated below the field.
Lake Tahoe	Checkbox	Check this box if you are applying for a Lake Tahoe license plate.
Olympic Training Center	Checkbox	Check this box if you are applying for an Olympic Training Center license plate.
Prisoner of War (DOCUMENTATION REQUIRED)	Checkbox	Check this box if you are applying for a Prisoner of War license plate; documentation is required.
Yosemite	Checkbox	Check this box if you are applying for a Yosemite license plate.
Veterans	Checkbox	Check this box if you are applying for a Veterans license plate; an organizational code must be provided.
Veterans Plate Organizational Code	Text	Enter the organizational code for the Veterans plate type.
Public Utilities Commission (PUC Livery)	Checkbox	Check this box if you are applying for a Public Utilities Commission (PUC Livery) license plate; a copy of the PUC permit must be attached.
Reason for Replacement
Lost	Checkbox	Check this box if the reason for replacement is that the license plate was lost.
Mutilated	Checkbox	Check this box if the reason for replacement is that the license plate was mutilated or damaged.
Stolen	Checkbox	Check this box if the reason for replacement is that the license plate was stolen.
New Design	Checkbox	Check this box if the reason for replacement is to obtain a plate with a new design.
Second Plate Choice
Second Choice Plate Configuration	Text	Enter the desired plate configuration for your second plate choice, using letters, numbers, slashes for half spaces, and asterisks for full spaces. Max length: 7 characters
Signature Date
Signature Date	Date	Enter the date the form is signed.
Third Plate Choice
Third Plate Choice	Text	Enter the desired content for the third plate choice. Max length: 7 characters
Vehicle Assignment
Auto	Checkbox	Check this box if the special interest license plate will be assigned to an automobile.
Truck	Checkbox	Check this box if the special interest license plate will be assigned to a truck.
Trailer	Checkbox	Check this box if the special interest license plate will be assigned to a trailer.
Motorcycle	Checkbox	Check this box if the special interest license plate will be assigned to a motorcycle.

California DMV Form REG 17 (Rev. 7/2012), Special Interest License Plate Application Instructions