Motor Vehicle License Special Plate Request form
INSTRUCTIONS FOR FILING THE APPLICATION
- Complete Sections A & D only.
- Attach check payable to "Grand Lodge of Pennsylvania" for $25.00 (Include cost for additional registration cards, if desired.)
- DO NOT MAIL IT TO THE BUREAU OF MOTOR VEHICLES.
- Mail completed application, and check or money order to:
|Grand Lodge of Pennsylvania|
|One North Broad Street|
| Philadelphia, PA 19107-2598|
- The Grand Secretary's Office will validate your membership, complete sections B & C, and will forward it to the Bureau of Motor Vehicles.
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