DIVISION OF MOTOR VEHICLES Bureau of Titles and Registrations 2900 Apalachee Parkway Neil Kirkman Building, MS# 74 Tallahassee, 32399

SAMPLE LICENSE PLATE REQUEST

The following license plates are available as sample plates and may be purchased by submitting a written request or this form, indicating the type of license plate being ordered and payment of $28 per license plate. The sample license plate is printed with "SAMPLE." The check must be made payable to Division of Motor Vehicles and mailed to the address listed above.

Sample plates are only provided for the license plates listed below; no other sample plates are available.

Florida Graphic State Motto In We Trust

COLLEGIATE

Barry University Florida Institute of Technology Saint Leo University Bethune-Cookman University Florida International University Saint Thomas University Clearwater Christian College Florida Memorial University Southeastern University Eckerd College Florida Southern College Stetson University Edward Waters College Florida State University University of Embry-Riddle Aeronautical University Jacksonville University University of Florida Flagler College Lynn University University of Florida A & M University New College of Florida University of Florida Atlantic University Nova Southeastern University University of Florida College Palm Beach Atlantic University University of Tampa Florida Gulf Coast University Ringling School of Art & Design University of Florida Hospital College of Health Sciences Rollins College Warner Southern College

MISCELLANEOUS

A State of Vision Florida Biodiversity Motorcycle Specialty St. Johns River Agriculture Education Foundation (Discover Wild NASCAR State Of The Arts Agriculture Florida) Navy State Wildflower Air Force Florida Horse Park (Discover Olympic Spirit Stop Child Abuse American Red Cross Florida’s Horses) Parents Make A Difference Stop Heart Disease Animal Friend Florida Sheriffs Youth Play Tennis Support Autism Programs Aquaculture Ranches Police Athletic League Support Education Army Go Fishing Protect Florida Springs Support Florida Special Catch Me, Release Me Golf Capital Of The World Protect Florida Whales Olympics Challenger/Columbia Helping Sea Turtles Survive Protect Our Reefs Support Homeownership For Choose Life Horse Country Protect The Panther All Coast Guard Hospice: Every Day Is A Gift Protect Wild Dolphins Support Law Enforcement Conserve Wildlife Imagine Salutes Firefighters Support Our Troops Discover Florida's Oceans In God We Trust Salutes Veterans Support Soccer Donate Organs, Pass It On Indian River Lagoon Save Our Seas Tampa Bay Estuary End Breast Cancer Invest In Children Save The Manatee Trees Are Cool River Of Grass Keep Kids Drug Free Scouting Teaches Values United We Stand Family First Kids Deserve Justice Share The Road U S Paratrooper Family Values Live The Dream Sportsmen’s National Land Visit Our Lights Fish Florida Marine Corps Trust

Professional Sports Teams

Florida Marlins Miami Dolphins Tampa Bay Buccaneers Florida Panthers Miami Heat Tampa Bay Lightning Jacksonville Jaguars Orlando Magic Tampa Bay Rays

Please provide a telephone number and/or e-mail address in case we have a question regarding your order.

Mail to Information Name: Address: City: State: Zip: Telephone: E-Mail Address:

HSMV 83000 (Rev. 12/10) S