Fillable Application for Surviving Spouse of a Veteran License (Texas Department of Motor Vehicles)

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Application for Surviving Spouse of a Veteran License (Texas Department of Motor Vehicles)

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The Application for Surviving Spouse of a Veteran License (Texas Department of Motor Vehicles) form is 3 pages long and contains:

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Country of origin: US
File type: PDF

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First Name
Middle Name
Last Name
Suffix
County
Address
City
State
ZIP
Email
Phone
Vehicle Identification Number
Current TX Plate
Make
Body Style
Empty Weight (lbs.)
Passenger car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motorcycle/Moped Trailer
Deceased Spouse TX Plate
No.
License No
Mo/Yr of Exp
Date Issued
Application for Surviving Spouse
of a Veteran License Plates
For County Use Only
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. When the specialty plate is issued, additional fees may be collected to
establish a single expiration date for both the specialty plate and the vehicle registration. Most specialty plates may be personalized for
an additional $40 fee; make your choice on page 3.
State law limits issuance of these plates to spouses who remain unmarried.
Surviving Spouse Disabled Vetera
n Plate: The surviving spouse of a disabled veteran may apply for this specialty plate. A $3 s
pecialty
plate fee is required for the first set of plates. Surviving spouses must complete a separate form and pay annual registration fees for
each additional vehicle.
Military Service Plate: The surviving spouse of a military veteran may register only one vehi
cle with the specialty license plate indicated.
The annual registration fee must be paid.
Military Recognition Plate: The surviving spouse of a military veteran may register one vehicle with a Pea
rl Harbor Survivor or Purple
Heart Medal plate. A $3 specialty plate fee is required.
If you place your order by mail, please contact your county tax assessor-collector’s office in three weeks to verify your plates are ready.
Contact your count
y tax assessor-collector if you have any questions.
Applicant Information
Vehicle Information
Vehicle Type:
General Requirements
•
Texas title and vehicle registration must be in your name.
•
If the plate is to be registered to a vehicle that is not titled in your name, attach a statement to this application stating
that you have legal right of possession and control of this vehicle at all times.
•
If you recently submitted an application for title, attach a copy of the title application receipt (VTR-500 RTS).
•
Submit a separate application for additional vehicles to be registered with Surviving Spouse Disabled Veteran plates.
•
If the vehicle is leased, attach a copy of the lease agreement.
•
Vehicle is for personal useonly.
•
You must be unmarried and sign the statement below to obtain this specialty plate.
Certification – State law makes falsifying information a third degree felony
Date
I, the applicant listed above, meet
the eligibility requirements as listed on this form and am providing proof to that effect.
Signature
Form VTR-425 Rev. 8/2019 Form available
online at www.TxDMV.gov Page 1 of 3
Application for Surviving Spouse of a Veteran License Plate
Specialty Plate Choices – All plates below are available for passenger cars and trucks up to 18,000 lbs. Plates available for
motorcycles/mopeds are indicated by (M); those available for trailers are indicated by (T).
Surviving Spouse Disabled Veteran ($3) (M), or
Circle your specialty plate choice below or enter your choice here:
• 11
th
Armored Cavalry Regiment
• 36
th
Infantry Division (M) (T)
• 173
rd
Airborne Brigade
• Armed Forces Expeditionary Medal (M) (T)
• Armed Forces Reserve (M) (T)
• Armed Forces Service Medal (M) (T)
• Combat Action Badge (M) (T)
• Combat Infantryman Badge (M) (T)
• Combat Action Ribbon U.S. Coast Guard (M) (T)
• Combat Action Ribbon U.S. Navy and Marine Corps (M) (T)
• Commendation Medal U.S. Air Force (M) (T)
• Commendation Medal U.S. Army (M) (T)
• Commendation Medal U.S. Coast Guard (M) (T)
• Commendation Medal Joint Services (M) (T)
• Commendation Medal U.S. Navy and Marine Corps (M) (T)
• Commendation Medal with Valor U.S. Air Force (M) (T)
• Commendation Medal with Valor U.S. Army (M) (T)
• Commendation Medal with Valor U.S. Coast Guard (M) (T)
• Commendation Medal with Valor Joint Services (M) (T)
• Commendation Medal with Valor U.S. Navy and Marine Corps (M) (T)
• Desert Shield/Desert Storm National Defense Service Medal (M) (T)
• Desert Shield/Desert Storm Southwest Asia Service Medal (M) (T)
• Enduring Freedom (M)
• Enduring Freedom Afghanistan Medal (M)
• Global War on Terrorism Expeditionary Medal (M) (T)
• Global War on Terrorism Service Medal (M) (T)
• Honorably Discharged U.S. Air Force
• Honorably Discharged U.S. Army
• Honorably Discharged U.S. Coast Guard
• Honorably Discharged U.S. Marine Corps
• Honorably Discharged U.S. Navy
• Inherent Resolve Campaign Medal (M) (T)
• Korean Defense Service Medal (M) (T)
• Korean Service Medal (M) (T)
• Kosovo Campaign Medal (M) (T)
• Marine Corps Expeditionary Medal (M) (T)
• Marine Corps League
• Master Army Aviator Badge
• Merchant Marine Expeditionary Medal (M) (T)
• Military Outstanding Volunteer Service Medal
• National Defense Service Medal Korea (M) (T)
• National Defense Service Medal Vietnam (M) (T)
• Navy Expeditionary Medal (M) (T)
• Nuclear Deterrence Operations Service Medal
• Operation Iraqi Freedom Medal (M) (T)
• Pearl Harbor Survivor ($3)
• Purple Heart Recipient Medal (M) ($3)
• Retired U.S. Air Force (M) (T)
• Retired U.S. Army (M) (T)
• Retired U.S. Coast Guard (M) (T)
• Retired U.S. Marine Corps (M) (T)
• Retired U.S. Navy (M) (T)
• Texas National Guard (M) (T)
• Texas Wing Civil Air Patrol
• Tomb Guard
• U.S. Air Force (M) (T)
• U.S. Air Force Academy (M)
• U.S. Army (M) (T)
• U.S. Coast Guard (M) (T)
• U.S. Coast Guard Academy (M)
• U.S. Coast Guard Auxiliary
• U.S. Marine Corps (M) (T)
• U.S. Merchant Marine (M)
• U.S. Merchant Marine Academy (M)
• U.S. Military Academy, West Point (M)
• U.S. Naval Academy (M)
• U.S. Navy (M) (T)
• U.S. Paratrooper (M)
• Vietnam Service Medal (M) (T)
• World War II Veterans Medal
• Woman Veteran (M)
Form VTR-425 Rev. 8/2019 Form available online at www.TxDMV.gov P
age 2 of 3
Application for Surviving Spouse of a Veteran License Plate
Personalize Your Plate – If you would like to personalize your specialty plate, there will be a $40 fee per year in addition to the annual
registration fee (if required).
• Show personalizations exactly as you want them to appear on your license plate(s). You may list more than one option in the
event the personalization you have chosen has been issued. Texas National Guard plates cannot be personalized due to the
design.
• 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, truck, and trailer plates are limited to six (6) characters total, including punctuation characters.
• U.S. Paratrooper plates are limited to five (5) characters total due to the plate design.
• Motorcycle/moped plates are limited to four (4) characters total, including punctuation characters.
• You are not required to use all the blocks provided.
• 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.
Vehicle One
1
st
Choice
2
nd
Choice
3
rd
Choice
Vehicle
Two
1
st
Choice
2
nd
Choice
3
rd
Choice
International Symbol of Access
To display the International Symbol of Access on your license plate, attach a signed Application for Persons with Disabilities Parking
Placard and/or License Plate (Form VTR-214) to this application to show your eligibility. Contact your county tax assessor-collector’s
office for more information.
Form VTR-425 Rev. 8/2019 Form available online at www.TxDMV.gov Page 3 of 3
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Application for Surviving Spouse of a Veteran License (Texas Department of Motor Vehicles)

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Completed 9 January 2021

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