VEHICLE IDENTIFICATION NUMBERCURRENT PLATE NUMBER
DATESIGNATURE OF DISABLED VETERAN
PRINTED NAME OF DISABLED VETERAN TELEPHONE NUMBER
DATESIGNATURE OF PERSON MAKING STATEMENT
STK # 300374735-6736 (3-21)
If you would like information about veteran benefits call 1-800-692-9666 or go to
DISABLED VETERAN PLATES
If the disabled veteran cannot sign this application, the following statement must be completed.
I am making the certification on behalf of the disabled veteran, who cannot sign this application.
Disabled Veteran plates are only issued to qualifying disabled veterans.
To apply for Disabled Veteran plates, submit:
This completed form.
A letter or DD214 from the U.S. Department of Veterans’ Affairs or
any branch of the U.S. Armed Forces showing that you have a
service-connected or service-related disability.
A Certificate of Compliance from the Department of Environmental
Quality (DEQ) if the vehicle is being registered within the DEQ
emission testing boundaries and is not exempt.
An Application for Registration (Form 735-268) if only applying for
registration, or Application for Title and Registration (Form 735-226)
and all title requirements, if applying for title with registration.
I will NOT park in spaces reserved for disabled person parking
unless I have a valid Disability Parking Permit.
I will only have one disabled veteran plate or set of plates.
I am a registered owner or lessee of the vehicle listed on this form.
I understand it is a crime under ORS 803.385 to certify the truth of a
statement when I know it is not true. Such a crime is a Class A
misdemeanor and is punishable by a jail sentence of up to 1 year, a
fine of up to $6,250 or both.