Fillable Disabled Veteran License Plates and/or Parking Placards Application (Texas Department of Motor Vehicles)

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Disabled Veteran License Plates and/or Parking Placards Application (Texas Department of Motor Vehicles)

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License No
Mo/Yr of Exp
Date Issued
Address City State ZIP
Email Driver License No. Phone Number
I I
First Name
Middle Name
Last Name
Suffix (if any)
Vehicle Identification Number
Current TX Plate (if any)
Year
Make
Body Style
Passenger Car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motor home Motorcycle/Moped
Check for one disabled parking placard to be issued wit
h the DV
plates. The appropriate Vehicle Type above must be indicated.
Check for the ISA to appear on the DV plate. The appropriate Vehi
cl
e Type above must be indicated.
Disabled Veteran plate (standard design) Disabled Veteran pl
ate with Emblem (select design choice on page 2)
50 percent or more
40 percent or more due to amputation
of a lower extremity
Agency
Address
Name and Title of Certifying Officer
Date
Texas Department
of
Motor Vehicles
Application for
Disabled Veteran License Plates
and/or Parking Placards
For County Use Only
Instructions
Submit the completed application and payment in the form of a personal check, money order, or cashier’s check with proof of
eligibility to your local county tax assessor-collector’s office. Do not mail cash. One vehicle is eligible for a $3 Disabled Veteran (DV)
license plates. Additional vehicles may display a DV license plate; however, registration and local fees will apply.
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 or if you have any questions.
Applicant Information
Vehicle – Annual $3 specialty license plate fee applies for the first set of plates only. Otherwise registration and local fees apply.
Vehicle Type:
Parking Placard: Owners of pas
senger cars, trucks, and motor h
omes ma
y be issued a disabled parking placard with approval of this
application.
International Symbol of Access (ISA) on a motorcycle/moped pla
te: The ISA is available for motorcycle and moped DV plates.
Check ONE Plate Design:
Proof of Eligibility – To be completed by a U.S. Department of Veterans Affairs Regional Office or appropriate service branch.
The Texas Department of Motor Vehicles will accept either a letter from the U.S. Department of Veterans Affairs certifying the
applicant’s disability percentage, or this
section must be completed. The records of this agency reflect the following service-connected
disability rating for the veteran named above (check one):
Certifying Officer Signature
Certification – State law makes falsifying information a third degree felony.
I, the applicant listed above, meet the eligibility requirements as li
sted above and am providing proof to that effect.
Signature
Form VTR-615 Rev. 12/2019 Form available online at www.TxDMV.gov Page 1 of 3
Application for Disabled Veteran License Plates and/or Parking Placards
Disabled Veteran Plate with Emblem – Options in lieu of the standard “Disabled Veteran” plate. See “Additional
Requirements” for these plates on page 3, and select a design choice below only if you checked the box on page 1 for “Disabled
Veteran plate with Emblem.”
Circle your specialty plate choice below or enter your choice here:
• 11th Armored Cavalry Regiment
• 36th Inf
antry Division
• 173rd Airborne Brigade
• Air Force Cross Medal
• Air Medal
• Air Medal with Valor
• Airman's Medal
• Armed Forces Expeditionary Medal
• Armed Forces Service Medal
• Army Distinguished Service Cross Medal
• Army of Occupation Medal
• Bronze Star Medal
• Bronze Star Medal with Valor
• China Service Medal
• Coast Guard Medal
• Combat Action Badge
• Combat Action Medal
• Combat Action Ribbon, U.S. Coast Guard
• Combat Action Ribbon, U.S. Navy and Marine Corps
• Combat Infantryman Badge
• Combat Medical Badge
• Commendation Medal, U.S. Air Force
• Commendation Medal, U.S. Army
• Commendation Medal, U.S. Coast Guard
• Commendation Medal, Joint Services
• Commendation Medal, U.S. Navy and Marine Corps
• Commendation Medal with Valor, U.S. Air Force
• Commendation Medal with Valor, U.S. Army
• Commendation Medal with Valor, U.S. Coast Guard
• Commendation Medal with Valor, Joint Services
• Commendation Medal with Valor, U.S. Navy and Marine Corps
• Defense Meritorious Service Medal
• Defense Superior Service Medal
• Desert Storm National Defense Service Medal
• Desert Storm Southwest Asia Service Medal
• Distinguished Flying Cross Medal
• Distinguished Flying Cross Medal with Valor
• Distinguished Service Medal, U.S. Air Force
• Distinguished Service Medal, U.S. Army
• Distinguished Service Medal, U.S. Coast Guard
• Distinguished Service Medal, U.S. Department of Defense
• Distinguished Service Medal, U.S. Department of Homeland Security
• Distinguished Service Medal, U.S. Department of Transportation
• Distinguished Service Medal, U.S. Navy
• Enduring Freedom Afghanistan Medal
• Global War on Terrorism Expeditionary Medal
• Global War on Terrorism Service Medal
• Inherent Resolve Campaign Medal
• Korean Defense Service Medal
• Korean Service Medal
• Korean War National Defense Service Medal
• Kosovo Campaign Medal
• Legion of Merit Medal
• Marine Corps Expeditionary Medal
• Master Army Aviator Badge
• Medal of Honor, U.S. Air Force
• Medal of Honor, U.S. Army
• Medal of Honor, U.S. Navy
• Merchant Marine Expeditionary Medal
• Meritorious Service Medal
• Military Outstanding Volunteer Service Medal
• Navy Cross Medal
• Navy Expeditionary Medal
• Navy and Marine Corps Medal
• Nuclear Deterrence Operations Service Medal
• Operation Iraqi Freedom Medal
• Prisoner of War Medal
• Purple Heart Recipient Medal
• Silver Star Medal
• Soldier's Medal
• Standard General Issue license plate
• Tomb Guard
• U.S. Air Force
• U.S. Air Force Academy
• U.S. Army
• U.S. Coast Guard
• U.S. Coast Guard Academy
• U.S. Marine Corps
• U.S. Merchant Marine Academy
• U.S. Military Academy – West Point
• U.S. Naval Academy
• U.S. Navy
• Vietnam Service Medal
• Vietnam Era - National Defense Service Medal
• Woman Veteran
Form VTR-615 Rev. 12/2019 Form available online at www.TxDMV.gov
Page 2 of 3
I I I 1 1 1
Application for Disabled Veteran License Plates and/or Parking Placards
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.
• 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.
• 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).
• Personalized plates must include “DV” as a prefix or suffix, which counts as two (2) characters.
• Passenger car and truck plates are limited to six (6) characters total, including punctuation characters.
• Motorcycle/moped plates are limited to six (6) characters total without an emblem and four (4) characters total with an
emblem, including punctuation characters.
• The International Symbol of Access (ISA) “ ” 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 ISA.
State law does not allow the ISA on a vehicle weighing more than 18,000 lbs.
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
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:
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 Republic of Korea or the contiguous water out 12 nautical miles 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 August 2, 1990, and November 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.
11th Armored Cavalry Regiment: You serve or have served in the 11th Armored Cavalry Regiment of the U.S. Army.
36th Infantry Division: You serve or have served in the 36th Infantry Division of the U.S. Army of the Texas Army National Guard.
Enduring Freedom: You participated in Operation Enduring Freedom.
Enduring Freedom Afghanistan: You participated in Enduring Freedom Afghanistan.
Operation Iraqi Freedom: You participated in Operation Iraqi Freedom.
Prisoner of War: You must provide an official U.S. government document or certification from the U.S. Department of Veterans
Affairs certifying or identifying you as a former prisoner of war.
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. 12/2019
Form available online at www.TxDMV.gov Page 3 of 3
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Disabled Veteran License Plates andor Parking Placards Application (Texas Department of Motor Vehicles)

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Completed 31 May 2021

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