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Name of Specialty Plate Being Requested Date Current License Plates Number Expiration Date Vehicle Owner s Name Address City State ZIP Daytime Telephone Number 8 a.m.-4 30 p.m. FOR OFFICE USE ONLY Signature Amount Enclosed Fee Received check number Printed by authority of the State of Illinois. November 2016 1 VSD 702. 2 4. 375 3. 375 11. 25 LAND OF LINCOLN Ovarian Cancer Awareness O C In addition to leaving room for the embossed items Land of Lincoln and Illinois space must be reserved for t ...

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