California DMV Form REG 17 (Rev. 7/2012), Special Interest License Plate Application Instructions
This form contains 82 fields organized into 16 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Application Type (Original / Conversion / Replacement / Reassign) | ||
| ORIGINAL | Checkbox |
Check this box when applying for a Special Interest License Plate for the first time (assigning the special interest plate to a vehicle currently registered in California).
|
| CONVERSION | Checkbox |
Check this box when converting an existing plate to a Special Interest License Plate (replacing your current plate with a special interest plate on a California-registered vehicle).
|
| REPLACEMENT | Checkbox |
Check this box when requesting a replacement Special Interest License Plate (for example, because the plate is lost, stolen, or damaged).
|
| REASSIGN, RETAIN, RELEASE | Checkbox |
Check this box when you want to reassign the special interest plates to another vehicle, retain them for future use, or release them (remove them from a vehicle) prior to transfer or sale.
|
| First Requested Plate Choice | ||
| First Requested Plate Choice - Plate Text | Text |
Enter the exact letters, numbers, spaces (use '/' for 1/2 space or '*' for a full space) and any punctuation for the first plate configuration you want reserved. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| First Requested Plate Choice - Meaning | Text |
Provide a short explanation of the intended meaning or significance of the first requested plate text so the department can assess and approve the request. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| General | ||
| Enter first choice, first letter or character | Text | |
| enter second letter or character | Text | |
| enter third letter or character | Text | |
| enter fourth letter or character | Text | |
| enter fifth letter or character | Text | |
| enter sixth letter or character | Text | |
| enter seventh letter or character | Text | |
| second choice. enter first lettor or character | Text | |
| enter second letter or character | Text | |
| enter third letter or character | Text | |
| enter fourth letter or character | Text | |
| enter fifth letter or character | Text | |
| enter sixth letter or character | Text | |
| enter seventh letter or character | Text | |
| third choice. enter first letter or character | Text | |
| enter second letter or character | Text | |
| click to print | Button | |
| click to clear form | Button | |
| Gift Statement - Recipient Name (Last, First, Middle) | ||
| Recipient Last Name | Text |
Enter the recipient’s last name (family or surname) as it should appear on the gift statement.
|
| Recipient First Name | Text |
Enter the recipient’s first (given) name as it should appear on the gift statement.
|
| Recipient Middle Name | Text |
Enter the recipient’s middle name or initial as it should appear on the gift statement; leave blank if none.
|
| Plate Configuration and Centering Options | ||
| Plate Configuration Entry | Text |
Enter the exact characters you want printed on the plate (letters, numbers, and symbols), using '/' to indicate a half-space and '*' to indicate a full space; include any spaces or punctuation exactly as you want them to appear. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| If you do not want the plate centered, check this box | CheckBox |
Depends on:
ORIGINAL, CONVERSION
|
| Plate Owner - Plate #, Full Name and Mailing Address | ||
| Plate Owner - Plate Number | Text |
Enter the special interest license plate number to be assigned to the plate owner (letters and/or numbers as shown).
|
| Plate Owner - Last Name | Text |
Enter the plate owner's last name exactly as it should appear on the registration or mailing address.
|
| Plate Owner - First Name | Text |
Enter the plate owner's first name.
|
| Plate Owner - Middle Name | Text |
Enter the plate owner's middle name or initial, or leave blank if none.
|
| Plate Owner - Mailing Address | Text |
Enter the plate owner's mailing address (street address or P.O. Box).
|
| Plate Owner - City | Text |
Enter the city for the plate owner's mailing address.
|
| Plate Owner - State | Text |
Enter the two-letter state abbreviation for the plate owner's mailing address.
|
| Plate Owner - ZIP Code | Text |
Enter the ZIP code for the plate owner's mailing address.
|
| Plate Type Selection (Section 2, Part 4 list of plate choices) | ||
| Section 2, Part 4 - Environmental License Plate (ELP) | Checkbox |
Check this box when you want to order the Environmental License Plate (ELP) for your vehicle.
|
| Section 2, Part 4 - Arts | Checkbox |
Check this box when you want to order the Arts specialty license plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - California Agricultural (CalAg) | Checkbox |
Check this box when you want to order the California Agricultural (CalAg) specialty plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - CA Firefighter (Documentation Required) | Checkbox |
Check this box when you want to order the CA Firefighter plate and you will attach the required documentation. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - California Memorial | Checkbox |
Check this box when you want to order the California Memorial specialty plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Coastal Commission (Whale Tail) | Checkbox |
Check this box when you want to order the Coastal Commission (Whale Tail) plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Collegiate (only UCLA available) | Checkbox |
Check this box when you want to order the Collegiate plate (note: only UCLA is available). Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Kids (Circle Symbol Below) | Checkbox |
Check this box when you want to order a Kids plate and circle the desired symbol location as indicated below. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Lake Tahoe | Checkbox |
Check this box when you want to order the Lake Tahoe specialty plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Olympic Training Center | Checkbox |
Check this box when you want to order the Olympic Training Center plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Prisoner of War (Documentation Required) | Checkbox |
Check this box when you want to order the Prisoner of War plate and will provide the required documentation. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Yosemite | Checkbox |
Check this box when you want to order the Yosemite specialty plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Veterans | Checkbox |
Check this box when you want to order the Veterans plate (provide any requested organizational code or supporting information as indicated). Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 — Veterans Organizational Code | Text |
Enter the organizational code for the Veterans plate (the code assigned to your veterans organization) exactly as provided to register this special interest plate. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Section 2, Part 4 - Public Utilities Commission (PUC Livery) | Checkbox |
Check this box when you want to order the Public Utilities Commission (PUC Livery) plate and attach a copy of your PUC permit. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Reassign/Retain/Release - Plate and VIN Information | ||
| Special Interest Plate Number | Text |
Enter the special interest license plate number that is being reassigned, retained, or released. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Removed From (VIN) | Text |
Enter the full Vehicle Identification Number (VIN) of the vehicle the plates are being removed from. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Placed On (Current License Plate Number) | Text |
Enter the current license plate number of the vehicle onto which the special interest plates are being placed. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Placed On (VIN) | Text |
Enter the full Vehicle Identification Number (VIN) of the vehicle onto which the special interest plates are being placed. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Reassign/Retain/Release - Retain / Fee / Release Options | ||
| Retain for future use (Annual Fee Required) | Checkbox |
Check this box when you want to retain the special interest plate for future use and understand that an annual fee is required. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Fee enclosed (See info on back) | Checkbox |
Check this box when you are enclosing the required fee with this form to pay the annual retention charge. Fill only if 'REASSIGN, RETAIN, RELEASE', 'Retain for future use (Annual Fee Required)' is 'Yes' for all fields selection.
Depends on:
REASSIGN, RETAIN, RELEASE, Retain for future use (Annual Fee Required)
|
| Release interest | Checkbox |
Check this box when you want to release your interest in the special interest plate and not retain or reassign it. Fill only if 'REASSIGN, RETAIN, RELEASE' is 'Yes'.
Depends on:
REASSIGN, RETAIN, RELEASE
|
| Replacement Request - Quantity and Reason | ||
| One Plate | Checkbox |
Check this box when you are requesting a replacement for one license plate. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| Two Plates | Checkbox |
Check this box when you are requesting replacements for two license plates. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| Lost | Checkbox |
Check this box when the plate(s) were lost and you are requesting replacements. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| Mutilated | Checkbox |
Check this box when the plate(s) were damaged or mutilated and you need replacements. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| Stolen | Checkbox |
Check this box when the plate(s) were stolen and you are requesting replacements. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| New Design | Checkbox |
Check this box when you want replacement plates issued because you are requesting a new plate design. Fill only if 'REPLACEMENT' is 'Yes'.
Depends on:
REPLACEMENT
|
| Second Requested Plate Choice | ||
| Second Requested Plate Choice | Text |
Enter the exact plate configuration you want reserved as your second choice (write the characters exactly as you want them to appear). Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| Second Choice Meaning | Text |
Provide a brief explanation of the meaning or significance of your second plate choice so the department can verify and approve the request. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| Signature - Date and Daytime Phone | ||
| Date Signed | Date |
Enter the date you signed the form.
|
| Daytime Phone — Area Code | Text |
Enter the 3-digit area code for your daytime telephone number.
|
| Daytime Phone — Local Number | Text |
Enter the remaining digits of your daytime telephone number (the local number portion).
|
| Third Requested Plate Choice | ||
| Third Choice — Plate Text | Text |
Enter the exact characters you want displayed on the third requested specialty plate choice, using slashes (/) for 1/2 spaces and asterisks (*) for full spaces as needed. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| Third Choice — Meaning / Explanation | Text |
Provide a short, clear explanation of the meaning or significance of the third requested plate configuration so the department can evaluate and approve the requested text. Fill only if 'ORIGINAL', 'CONVERSION' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION
|
| Type of Plate Order - Personalization Option | ||
| Personalized | Checkbox |
Check this box when you want a personalized special interest license plate with custom characters or text chosen by you. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Non-Personalized | Checkbox |
Check this box when you want a non-personalized plate and will receive the next available plate in the series (no custom characters). Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Type of Plate Order - Pickup Location (DMV / Other / Auto Club) | ||
| Will pick up plates at: DMV Office (location) | Checkbox |
Check this box if you will pick up the specialty plates at a Department of Motor Vehicles (DMV) office, and write the DMV office location on the line provided. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| DMV Office Location | Text |
Enter the name or specific DMV office location (city, branch name, or office code) where you will pick up the plates. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Will pick up plates at: Auto Club (location) | Checkbox |
Check this box if you will pick up the specialty plates at an Auto Club location (Auto Club members only), and write the Auto Club location on the line provided. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Auto Club Location | Text |
Enter the Auto Club branch location or name where you will pick up the plates (for Auto Club members only). Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Type of Plate Order - Vehicle Type (Auto/Truck/Trailer/Motorcycle) | ||
| Auto | Checkbox |
Check this box when the special interest plate will be assigned to an automobile (auto) registration. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Truck | Checkbox |
Check this box when the special interest plate will be assigned to a truck registration. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Trailer | Checkbox |
Check this box when the special interest plate will be assigned to a trailer registration. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|
| Motorcycle | Checkbox |
Check this box when the special interest plate will be assigned to a motorcycle; also circle 'Motorcycle' on the form as instructed. Fill only if 'ORIGINAL', 'CONVERSION', 'REPLACEMENT' is 'Yes' for any fields selection.
Depends on:
ORIGINAL, CONVERSION, REPLACEMENT
|