Application for
Disabled Veteran License Plates
and/or Parking Placards
For County Use Only
License No
Mo/Yr of Exp
Date Issued
Instructions
Submit the completed application; payment in the form of a personal check, money order, or cashier’s check; and proof
of eligibility to your local county tax assessor-collector’s office. Do not mail cash. One vehicle is eligible for a $3 specialty license plate
fee. Additional vehicles may display a Disabled Veteran license plate; however, registration and local fees will apply.
The license plates may be personalized for an additional $40 fee; make your choice on page 3. The personalization fee will not be
refunded once the application is submitted. If you order by mail, please contact your county tax assessor-collector’s office in three
weeks to verify your plates are ready for issuance. Contact your county tax assessor-collector if you have questions.
Applicant Information
First Name
Middle Name
Last Name
Suffix
County
Address
City
ZIP
Email
Driver License No.
Phone Number
Vehicle 1 -
Annual $3 specialty license plate fee applies.
Vehicle Identification Number
Current Plate
Year
Make
Body Style
Empty Weight (lbs.)
Vehicle Type: Passenger Car
Truck (up to 18,000 lbs.)
Check for a parking placard in addition to the plates
Motorcycle/Moped
Check for the International Symbol
of Access (ISA) on the plate
Choose ONE plate design:
Disabled Veteran plate (standard) Disabled Veteran plate with emblem (indicate design choice on page 2)
Vehicle 2 -
Annual vehicle registration and local fees apply.
Vehicle Identification Number
Current Plate
Year
Make
Body Style
Empty Weight (lbs.)
Vehicle Type: Passenger Car
Truck (up to 18,000 lbs.)
Check for a parking placard in addition to the plates
Motorcycle/Moped
Check for the International Symbol
of Access (ISA) on the plate
Choose ONE plate design:
Disabled Veteran plate (standard) Disabled Veteran plate with emblem (indicate design choice on page 2)
Proof of Eligibility -
To be completed by a U.S. Department of Veterans Affairs Regional Office or appropriate service branch.
The records of this agency reflect the following service-connected disability rating for the above named veteran (check one):
50 percent or more 40 percent or more due to amputation of a lower extremity
Comment (if any)
Agency
__________________________________________ Address _______________________________________________
Name and Title of Certifying Officer
Certifying Officer Signature Date
Certification State law makes falsifying information a third degree felony.
I meet the eligibility requirements as listed above and am providing proof to that effect.
Signature __________________________________ Date
Form VTR-615 Rev. 9/2017 Form available online at www.TxDMV.gov Page 1 of 3
Disabled Veteran plate with emblem Options in lieu of the standard “Disabled Veteran” plate. See “Additional
Requirements” for these plates on page 3, and choose design choice below only if you checked the box on page 1 for
Disabled Veteran plate with emblem.”
11
th
Armored Cavalry Regiment
Distinguished Service Medal Army
36th Infantry Division
Distinguished Service Medal Coast Guard
Air Force
Distinguished Service Medal Department of Defense
Air Force Cross Medal Distinguished Service Medal Department of Homeland Security
Air Medal
Distinguished Service Medal Navy
Air Medal with Valor
Distinguished Service Medal Dept. of Transportation
Airman's Medal
Global War on Terrorism Expeditionary Medal
Armed Forces Expeditionary Medal
Global War on Terrorism Service Medal
Armed Forces Service Medal
Inherent Resolve Campaign Medal
Army
Korean Defense Service Medal
Bronze Star
Korean Service Medal
Bronze Star with Valor
Korean War National Defense Service Medal
Coast Guard
Kosovo Campaign Medal
Coast Guard Medal
Legion of Merit
Combat Action Badge
Marines
Combat Action Medal
Marine Corp Expeditionary Medal
Combat Action Ribbon Coast Guard
Merchant Marine Expeditionary Medal
Combat Action Ribbon Navy and Marines
Meritorious Service Medal
Combat Medical Badge
Military Outstanding Volunteer Service Medal
Combat Infantryman's Badge
Navy
Commendation Medal Air Force
Navy Expeditionary Medal
Commendation Medal with Valor Air Force
Navy and Marine Corps Medal
Commendation Medal Army
Navy Cross
Commendation Medal with Valor Army
Operation Enduring Freedom Afghanistan
Commendation Medal Coast Guard
Operation Iraqi Freedom
Commendation Medal with Valor Coast Guard
Prisoner of War
Commendation Medal Joint Services
Purple Heart Medal
Commendation Medal with Valor Joint Services
Silver Star
Commendation Medal Navy and Marine Corp
Soldier's Medal
Commendation Medal with Valor Navy and Marine Corp
Standard General Issue license plate
Defense Meritorious Service Medal
U.S. Air Force Academy
Defense Superior Service Medal
U.S. Coast Guard Academy
Desert Storm National Defense Service Medal
U.S. Merchant Marine Academy
Desert Storm Southwest Asia Service Medal
U.S. Military Academy
Distinguished Flying Cross Medal
U.S. Naval Academy
Distinguished Flying Cross Medal with Valor
Vietnam Service Medal
Distinguished Service Cross Medal Air Force
Vietnam War Nat’l. Defense Service Medal
Woman Veteran
Form VTR-615 Rev. 9/2017 Form available online at www.TxDMV.gov Page 2 of 3
Show personalizations exactly as you want them to appear on your license plate(s). You may list more than one option in
the e
vent the personalization you have chosen has been issued.
A personalization that has been issued, is deemed offensive, or conflicts with the regular license plate numbering system
cannot be approved.
Enter your desired personalized letters, numbers, and/or symbols in the blocks below. The available symbols include: a
period, a dash, a blank space, a Texas silhouette (use an asterisk “*” to indicate), a heart (use an at@” to indicate), and
a star (use an ampersand&” to indicate).
Passenger car and truck plates are limited to six (6) characters total, including punctuation characters.
Motorcycle/moped plates are limited to four (4) characters total, including punctuation characters.
The International Symbol of Access
counts as two (2) characters and will be located at the beginning of the plate
number. If you are disabled and applying for personalized specialty plates, use a percent “%” to indicate the International
Symbol of Access.
Personalization fee will not be refunded once the application is submitted.
1
st
Choice 2
nd
Choice 3
rd
Choice
Vehicle 1
Vehicle 2
Additional requirements to obtain an emblem design are listed on page 2.
You must include proof that you are an active member of the U.S. Armed Forces, a former member with an honorable discharge,
and you were awarded the applicable service medal, graduated from the listed military academy, or served as indicated below:
World War II: You served in the U.S. or Allied Armed Forces during World War II.
Korea: You served in:
the Armed Forces between June 27, 1950, and July 27, 1954, and received the National Defense Service Medal,
a combat zone in Korea between June 27, 1950, and July 27, 1954, and received the Korean Service Medal, or
the Korean Demilitarized Zone beginning July 28, 1954, and received the Korean Defense Service Medal.
Vietnam: You served in:
the Armed Forces between January 1, 1961, and August 14, 1974, and received the National Defense Service
Medal, or
a combat zone in the Republic of Vietnam between July 1, 1958, and March 28, 1973, and received the
Vietnam Service Medal.
Desert Shield or Desert Storm: You served in:
the Armed Forces between Aug. 2, 1990, and Nov. 30, 1995, and received the National Defense Service Medal, or
a combat zone in support of Operation Desert Shield or Desert Storm between August 2, 1990, and
November 30, 1995, and received the Southwest Asia Service Medal.
11
th
Armored Cavalry Regiment: You serve or have served in the 11th Armored Cavalry Regiment of the U.S. Army.
Enduring Freedom: You participated in Operation Enduring Freedom.
Operation Enduring Freedom Afghanistan: You participated in Operation Enduring Freedom Afghanistan.
Operation Iraqi Freedom: You participated in Operation Iraqi Freedom.
Military Academies: You graduated from the listed academy.
Woman Veteran: You are a female active or former member with honorable discharge from the U.S. Armed Forces,
Texas National Guard, or Texas State Guard.
Form VTR-615 Rev. 9/2017 Form available online at www.TxDMV.gov Page 3 of 3
Personalize Your Plate If you would like to personalize your specialty plate, there will be a $40 fee per year in addition to
the specialty plate fee or annual registration fee.