MVA USE ONLY

VR-335 (09-19)

6601 Ritchie Highway, N.E. Glen Burnie, Maryland 21062

Application for Plug-In Electric/ Vehicle HOV Permit

Applicant's Name: First, Middle, Last

Date of Birth Co-Applicant's Name: First, Middle, Last

Date of Birth

Applicant's Soundex/Maryland Driver License Number FEIN #

Applicant's Street Address

Co-Applicant's Soundex/Maryland Driver License Number FEIN #

Co-Applicant's Street Address

City or Town

County

State

Zip Code City or Town

County

State

Zip Code

Model Year

Make

Model

Vehicle Identification Number

Title Number

Plug-In Electric Vehicle HOV Permit

Please check the appropriate box: Original Issuance

Renewal

The above described vehicle must meet all of the qualifications listed below for Plug-in-Electric Vehicles used in High Occupancy Vehicle (HOV) lanes in the State of Maryland regardless of the number of passengers:

Plug-In Electric Vehicle HOV Permit

? The vehicle must be made by a manufacturer and be made primarily for use on public streets, roads and highways; and ? Has not been modified from original manufacturer specifications; or ? Has been modified from the manufacturer's original specification and made to be a plug-in electric vehicle. Please note:

Customers indicating their vehicle has been modified to become a plug-in electric vehicle, need to have their vehicle examined by the Maryland State Police prior to the issuance of an HOV permit. ? Is rated at not more than 8500 lbs unloaded gross vehicle weight; ? Has a maximum speed capability of at least 65 miles per hour; ? Is propelled to a significant extent by an electric motor that draws electricity from a battery that has a capacity of not less than 4 kilowatt-hours for 4-wheeled vehicles and not less than 2.5 kilowatt-hours for 2 or 3-wheeled motor vehicles; and ? Is capable of being recharged from an external source of electricity.

I/we certify that my vehicle meets the above qualifications and the required HOV permit will be affixed on the rear of the vehicle in a visible position within 12 inches of the registration plate (not on the window).

Signature of Applicant

Date

Signature of Co-Applicant

Date

MVA USE ONLY

Permit Number:

Title Number:

Expiration Year: For more information, please call: 410-768-7000 (to speak with a customer agent).

TTY for the hearing impaired: 1-800-492-4575. Visit our website at: MVA.

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