MVR-33A
Rev 8/2019
Military/Veteran’s Registration Plate Application
Please submit application to the Department of Military and Veterans Affairs Officer with a DD214 and/or VA Rating Letter prior to submitting to NCDMV
Section 1 I would like to apply (
) for the following license plate:
Please select only one (1) plate for each application
❑ **Afghanistan Veteran (suffix AV) - none
❑ **Partially Disabled Veteran (prefix PD) - none
❑ Air Medal Recipient (suffix AM) - $10.00
❑ **Pearl Harbor Survivor - none
❑ *Bronze Star Combat Recipient (Suffix V) – Free
❑ **Purple Heart Recipient Motorcycle (suffix PV) - none
❑ **Bronze Star Recipient (suffix BS) - none
❑ **Purple Heart Recipient (prefix PH) - none
❑ *Congressional Medal of Honor - Free
❑*Silver Star Disabled Veteran (prefix SD) - Free
❑ **Desert Storm Veteran (suffix GV) - none
❑ *Silver Star Recipient (suffix SS) - Free
❑ *Disabled Veteran (suffix DV) - Free
❑ **US Military Air Force Veteran (suffix VF) - none
❑ Distinguished Flying Cross (suffix FC) - $10.00
❑ **US Military Army Veteran (suffix VA) - none
❑ *Distinguished Service Cross (suffix DC) - Free
❑ **US Military Coast Guard Veteran (suffix VC) - none
❑ *Ex-Prisoner of War - Free
❑ **US Military Marine Veteran (suffix VM) – none
❑ **Gold Star Lapel Button (suffix GS) - none
❑**US Military Navy Veteran (suffix VN) – none
❑**Iraq Veteran (suffix IV) - none
❑ **Vietnam Era (suffix VV) - none
❑**Korean Conflict (suffix KV) - none
❑ **War on Terror (suffix WT)- none
❑**Legion of Merit (suffix LM)- none
❑ **World War II Veteran (suffix WV)- none
*One free plate per person, **No special fee – license plate fee is due
_____First in Flight Background _____ First in Freedom Background _____National/State Motto Background
When applying for a personalized Military/Veteran license plate, please remember the prefix/suffix representing the plate will be the first/last letters on the plate.
Personalized special plate choice must contain at least one alpha character. The personalized plate choice cannot be numbers only. Please note the prefix/suffix for the
plate. If you choose to personalize the plate, the cost will be an additional $30.00 personalized fee. Personalization may not be available on certain plates.
You are allowed four (4) spaces for a personalized message ___ ___ ___ ___
THE SPECIAL/PERSONALIZED FEE IS AN ANNUAL FEE DUE IN ADDITION TO LICENSE FEE
North Carolina Division of Motor Vehicles
3155 Mail Service Center
Raleigh, NC 27697-3155
Section 3 North Carolina Department of Military and Veterans Affairs
4001 Mail Service Center- Raleigh, NC 27699-4001
To be completed by a NC Division of Veterans Affairs County or State Veterans Service Officer prior to submitting the form to NCDMV or the License Plate Agency
The records of the Department of Military and Veterans Affairs indicates that the above applicant qualifies for a
____________________________________________special license plate
(Type of plate desired from the list above)
_______________________________________________________________________________________
Printed Name of the Director of the Department of Military and Veterans Affairs or the Director’s designee
_______________________________________________________________________________________
Signature of the Director of the Department of Military and Veterans Affairs or the Director’s designee Date
Section 2
Name (To agree with certificate of Title):
First Middle Last
Address
City State Zip Code
Driver License # State
Current NC Plate Number
YEAR MAKE BODY SYTLE
Owner’s Certificate of Insurance
I certify for the motor vehicle described above that I have financial responsibility as required by law.
Print or Type Full Name of Insurance Company Authorized in N.C. - Not Agency or Group Policy Number
______________________________________________________________________________________________________________________________________________________________________________________
SIGNATURE OF OWNER DATE OF CERTIFICATION
City State Zip Code
Driver License # State Current NC Plate Number
Name (To agree with certificate of Title):
CONTACT INFORMATION:
HOME PHONE: _________________________
HOFFICE/CELL PHONE: ______________________________
EMAIL: ________________________________________________
VEHICLE IDENTIFICATION NUMBER
