DM V
APPLICATION FOR
APPROVAL OF VETERAN
DEPARTMENT OF TRANSPORTATION
DRIVER AND MOTOR VEHICLE SERVICES
1905 LANA AVE NE, SALEM OREGON 97314
GROUP PLATES
REFER TO INFORMATION ON BACK
Evidence that supports group qualification must be attached to this application.
Evidence must include:
a.
A copy of the group‘s bylaws, organization papers, or other documents that show they are a non-profit veterans
organization.
b.
Any estimates the group may have for the sale of plates for the group during the next 12 months and information on
which the estimates are based.
c.
The words, letters, numbers (see plate design box below) requested to appear on the plates. See back of form for
information on military-related decals.
d. Fees to cover DMV’s costs related to the design and production of the requested plates. Please contact DMV for
information on current fee amounts: 503-945-5237.
NAME OF GROUP
CURRENT OFFICERS / OFFICIALS – (REFER TO INFORMATION ON REVERSE)
NAME ADDRESS DAY PHONE NUMBER
NAME ADDRESS DAY PHONE NUMBER
NAME ADDRESS DAY PHONE NUMBER
PLATE DESIGN
ACCOUNT INFORMATION
Words, letters or numbers requested to
appear on the plates naming or describing
the group. Characters A Z and 0 9 may
be used
P
P
PROCEEDS SHOULD BE DEPOSITED INTO THE FOLLOWING ACCOUNT NAME:
BANK/FINANCIAL INSTITUTION ACCOUNT NUMBER (PLEASE ATTACH VOIDED CHECK)
ADDRESS
SALE OF PLATES (Check one box)
Should not be restricted. (Any individual will be allowed to apply.)
Should be restricted to eligible parties. (Restrictions may be
service connected but may NOT be based on membership.)
If restriction is requested, define eligibility (i.e., Applicant must be a
Purple Heart recipient).
PLATE ESTIMATE
I estimate that DMV should order sets of plates to be
sold within the first 12 months of issuance.
I certify the information on this application is true and correct. I certify that my group has permission or is authorized to
use these words or military-related decal on a registration plate. I understand it is a crime, under ORS 803.385, to certify
the truth of a statement when I know the statement is not true. Such a crime is punishable by a jail sentence of up to 1
year, a fine of up to $6,250, or both.
SIGNATURE OF AUTHORIZED REPRESENTATIVE OF GROUP
DATE
735-7069 (0-9)
X
Clear Form
To qualify for group plates to be issued, a group must be a non-profit veterans organization
that:
a.
Has an established membership that includes officers and bylaws;
b.
Is physically located in Oregon or has a chapter that is physically located in Oregon; and
c.
Represents veterans of the Armed Forces of the United States, or is established for the purpose of supporting or
recognizing such veterans.
NAMES OF OFFICERS/OFFICIALS
List the name and address of the officer/official authorized to speak on behalf of the group in matters affecting group
plates. All groups must notify DMV anytime there is a change in the name or address of the officer/official.
ACCOUNT INFORMATION
A surcharge will be collected by DMV upon sale of these plates. Groups may specify an account into which the net
proceeds from the sale of the plates should be deposited. If no account is specified (i.e., this area is left blank), DMV will
deposit the proceeds into the Oregon Veteran’s Home Account. If your group chooses to receive the net proceeds from
the plates, you must attach a voided check from the account into which these proceeds may be electronically deposited.
PLATE ESTIMATE
Estimate the number of sets of plates that DMV can expect to sell within the first 12 months. DMV may set a maximum
number of sets that can be ordered at any one time, due to storage limitations.
PLATE DESIGN
Provide the word(s) or initials which are to appear on your group’s plate. These words
must name or describe your group and may not contain expressions of political
opinion or religious belief. Words must fit into approximately a 3" x 3" area.
Readability becomes difficult for letters less than 1/2" tall and for words with more
than 8 characters. If your group is using a military-related decal, you must supply a
color copy of the logo plus a camera ready separation and a digital file.
SALE OF PLATES
Any individual will be allowed to apply for group plates unless a group requests
restrictions. Restrictions may be service connected (e.g., Pearl Harbor group may
request that applicants be a Pearl Harbor Survivor to get their group plate).
Restrictions may not be based on membership (e.g., applicant will not be required to
be a member of a veterans’ club or association if they are otherwise eligible).
Veteran group plates are manu-
factured on white background
with an American flag and word
Veteran at the bottom of the
plate. The plates will contain a
generic plate configuration of 4
letters. This is an example of
what the plate will look like.
SUBMITTING APPLICATIONS
Mail the completed application, fees and documentation to:
DMV Vehicle Programs
1905 LANA AVE NE
SALEM OR 97314
If you have any questions about completing
the application you may contact
Vehicle Programs at: 503-945-5243
Do NOT submit this application to your local DMV office.
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