Tennessee Amateur Radio Special License Plate Application (Click to download PDF form)

DEPARTMENT OF REVENUE
TAXPAYER AND VEHICLE SERVICES DIVISION
44 VANTAGE WAY, SUITE 160
NASHVILLE, TENNESSEE 37243-8050
Application for Special Amateur Radio License Plates
Note: This application must be completed in its entirety for processing.
_____ Quantity of Special Amateur Radio License Plates
(Indicate Plate Type)
_______ Auto
_______ Motorcycle
Please list, if any, all currently assigned amateur radio plates:
______________________________________________________________________________
Federal Communication Commission Call Sign: ________________________________________
FCC Operator Privileges:__________________________________________________________
Effective Date: __________________________ Expiration Date: _________________________
Applicant’s Name (please print) ____________________________________________________
Street Address__________________________________________________________________
City _____________________________ State____________________ Zip__________________
County _________________________________ Telephone Number (_____) ________________
Certification Statement:
I certify that I am the recipient of the F.C.C. Amateur Radio Operator License referred to above (a
copy of which is attached), that I am a resident of the State of Tennessee, and that I have been
issued a Tennessee Certificate of Title or have applied for the same for the vehicle on which the
special plate(s) herein requested will be registered.
Signed: ___________________________ Date: ____________
(Applicant’s Signature)
Please do not send money with this application. Submit your completed application by mail to:
Vehicle Services Section
Taxpayer and Vehicle Services Division
44 Vantage Way, Suite 160
Nashville, TN 37243-8050
RV-F1312601 (rev 5/08)