Please help us get our own special interest license plate! We need 500 good faith commitments before the state will move forward with production of our plate. Please read the following...

I the undersigned verify the following:

• I am a resident of the state of Arkansas.
• I am the owner of one (1) or more vehicles. Unless prevented from doing so because of circumstances beyond my control, I will register at least one (1) vehicle I own with the special license plate named above, if such plates are approved by the Arkansas Department of Finance and Administration.
• I am aware that there are annual fees, in addition to the regular registration fees, for such special plates.
• I am aware that the Office of Motor Vehicles must receive a minimum of 500 signatures, $5,000, or a combination thereof, before this special plate can be ordered or issued; I am aware that, under A.C.A. 27-14-303, the penalty for making a false statement on a motor vehicle application, concealing a material fact, or otherwise committing a fraud in any motor vehicle application, upon conviction, is punishable by a fine of not more than one thousand dollars ($1000.00) or by imprisonment for not more than one (1) year or both.