STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
APPLICATION FOR PERSONALIZED PLATES
Form 803 (Rev. 10/29/2018) www.alaska.gov/dmv
803
VEHICLE AND OWNER
INFORMATION
FIRST NAME
MIDDLE NAME
LAST NAME
CURRENT PLATE OR SERIAL NUMBER (VIN)
MAKE
MODEL
MAILING ADDRESS
STATE
ZIP CODE
EMAIL ADDRESS
PHONE NUMBER
I WANT TO RECEIVE NOTIFICATIONS BY:
E-MAIL
MAIL
Use ONLY the following characters:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Ø 1 2 3 4 5 6 7 8 9
If a space is desired between characters, leave the block blank.
1
ST
CHOICE
MEANING: (This helps speed up the approval process for your plate)
2
ND
CHOICE
3
RD
CHOICE
PLATE SIZE REQUESTED:
LARGE (Car / Truck / Trailer)
SMALL (Motorcycle / Trailer)
GENERAL AVAILABILITY
DESIGNS
STANDARD PLATES - $30
BEAR*
CARIBOU
MOUNTAIN
BLUE / GOLD
*Bear will appear in center of plate
UNIVERSITY PLATES - $50
UAA
UAF
UAS
PWSCC
SUPPORT PLATES (Fees vary)
NRA ($50 initially + $30 on renewal)
CHOOSE LIFE ($30 initially + $30 on renewal)
IN GOD WE TRUST ($30 initially + $30 on renewal)
SUPPORT OUR TROOPS ($40 initially + $40 on renewal)
PRO-FAMILY, PRO- CHOICE ($30 initially + $30 on renewal)
COMMEMORATING VETERANS ($100 initially+ $35 on renewal)
BREAST CANCER AWARENESS ($50)
BLOOD BANK OF ALASKA ($50)
CELEBRATING THE ARTS ($30)
CHILDRENS TRUST ($100)
SPECIALIZED PLATES
See back for additional
requirements
MEMBERSHIP PLATES - $50
FREEMASON
LIONS CLUB
KNIGHTS OF COLUMBUS
IDITAROD FINISHER
INTERNATIONAL
ASSOCIATION OF FIRE
FIGHTERS (IAFF)
PIONEERS OF ALASKA
SPECIAL PROGRAM PLATES
FIRE FIGHTER / EMS ($30)
AMATEUR RADIO ($0 for a
blue/gold plate, must read and
initial back of form)
MILITARY PLATES - $30
ARMY
NAVY
MARINES
AIR FORCE
COAST GUARD
NATIONAL GUARD
LAO VETERAN
PRISONER OF WAR
PURPLE HEART
PEARL HARBOR SURVIVOR
GOLD STAR FAMILY
DISABLE VET W/ PRIVILEGES
DISABLE VET NO PRIVILEGES
UNIT EMBLEM (Fill in Unit) ____________________________
By signing below, I swear, under the penalty of perjury, that everything on this application is true and correct, and that I meet all of the legal requirements
and qualifications for the plate requested.
Signature
Date
By signing below as the “Authorizing Individual” I am certifying, under penalty of perjury, that the applicant above meets all of the legal requirements and
qualifications for the plate requested and that I am an appropriate authorizing party, as detailed on the back of this form.
Authorizing Individual (Signature, Printed Name, Title/Rank)
Date
DMV USE ONLY:
NEW CLASS
CODE
DATE
BATCH
LOGIN ID /
OFFICE
FEE: CA CC CK
Form 803 (Rev. 10/29/2018) www.alaska.gov/dmv
SPECIALIZED PLATE REQUIREMENTS
ARMY / AIR FORCE / MARINE / NAVY / COAST GUARD / UNIT EMBLEM
You must present a DD214, verification letter from the Veteran’s Administration, Active Duty ID card, Retiree ID Card, or a
current Leave and Earnings Statement (LES).
NATIONAL GUARD
All actively-serving members of the Alaska National Guard are eligible for this plate. You must show your Military ID and
provide a copy of page one from your Virtual Military Personnel Flight (Air) or your Personnel Qualification Record (Army).
GOLD STAR
Available to the parent, guardian, brother, sister, dependent, or spouse (unless remarried) of a member of the United
States armed forces that was killed in the line of duty. You must present a copy of the Report of Casualty (DD1300) from
the US Dept. of Veterans Affairs proving you are a qualified family member of the military member killed in the line of duty.
If you are not listed as a relative on the DD1300, you must present other documentation to prove eligibility.
LAO VETERAN
Available to veterans of military operations in support of the US in the Kingdom of Laos between 2/28/1961 and
5/15/1975. Present one of the following:
A document issued by the US Military during the required period showing membership in a service with a special
guerrilla unit or irregular forces in Laos;
An affidav
it from your superior officer or non-commissioned officer;
An affidavit from another individual that also served in an appropriate unit and has personal knowledge of your
service, or from a family member of an individual who personally knew of your service;
A signed Congressional Commendation for Vietnam War Service in Laos;
A commendation issued by the government of South Vietnam;
A pay record from the appropriate time period;
An identification card from the Lao Veterans of America, Inc., SGU Veterans and Families of USA, Inc. or other
organization that requires documentation of service.
AM
ATEUR RADIO OPERATOR
Available to Alaskans that hold a valid FCC amateur radio operator’s license AND carry an amateur radio transmitter in
their vehicle. Must present a copy of current FCC license. Please initial below:
_____ I certify my FCC license meets the requirements set forth in AS 28.10.181(i).
_____ I certify my vehicle is equipped with an antenna, a power supply and wiring that are a permanent part of the
vehicle as outlined in AS 28.10.421 (d) (8) (A) & (B) and that I qualify for free registration under this statute.
FIREFIGHTER / EMS
All active members and former members with at least 5 years of service in Alaska as a fire fighter or EMS provider. This
form must be signed by your Chief Officer or authorized representative on the line marked “Authorizing Individual”. If no
longer active, you must instead present documentation demonstration 10+ years of service as a fire fighter or EMS
provider in the State of Alaska.
FREEMASONS / LIONS CLUB / KNIGHTS OF COLUMBUS / INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS/
PIONEERS OF ALASKA /
Applicants must submit evidence of current membership for the organization.
IDITAROD FINISHER
Must present a letter from the Iditarod Trail Committee identifying you as an Iditarod Finisher.
DISABILITY PLATES
Must present a Special Disability Parking Permit (Form 861) indicating a permanent disability, to apply for any of the
disability plates with parking privileges OR submit certification from Veteran's Affairs (VA) stating you have a service-
related disability of 50% or more to qualify for a Disabled Veteran's Plate (with or without wheelchair logo parking
privileges).
CE
LEBRATING THE ARTS
Special request Celebrating the Arts plates change every 2 years. The plates fees collected may be appropriated by the
legislature to programs benefiting the arts.