State of Arkansas Office of Motor Vehicle Signature Form for a License Plate Decal
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Signatures included will be a part of our application to the Arkansas Dept of Motor Vehicles to offer a Sheep Dog Impact Assistance Special Interest License Decal. The special license plate decal will be placed on a standard issue Arkansas license plate across the bottom of the plate in lieu of the legend "The Natural State". 100% of the proceeds from the fund raising fee will go to helping the men and women of our military, law enforcement, fire & rescue and EMT communities. A group of people we call "Sheep Dogs". SDIA is recognized by the IRS as a 501c3 non-profit organization.
The application text reads:
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 Adminstration.
- I am aware that, in addition in the regular annual registration fee for the vehicle and an adminstrative and handling fee of $10.00, there may be an additional fund raising fee not to exceed $25.00.
- I am aware that the Office of Motor Vehicles must receive a minimum of 300 signatures, $3,000, or a combination thereof, before the 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 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 ($1,000) or by imprisonment for not more than one (1) year or both.
Our federal IEN number is 26-4521779, issued 6/22/2010.
For more information email firstname.lastname@example.org.