OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES NO FEE BMV USE ONLY APPLICATION FOR DISABLED VETERANS, FORMER PRISONERS OF WAR & SPOUSES OF DECEASED FORMER PRISONERS OF WAR LICENSE PLATES PLATE NUMBER ISSUE DATE IMPORTANT INSTRUCTIONS 1. 2. 3. 4. 5. Complete all blocks. Submit Certificate of Title or Memorandum Title, if this vehicle has not been permanently plated; (COPIES NOT ACCEPTED). Enter current plate number here: Spouses of Deceased Former Prisoners of War applicants must submit a copy of the Death Certificate/Marriage Certificate. An Affidavit for Registration (BMV 5712) is REQUIRED, if this vehicle is a non-commercial truck. Follow the directions listed below, for those plates for which application is being made. DISABLED VETERAN – If you are a disabled veteran, attach a current letter, dated with the last year, from the U.S. Department of Veterans Affairs (VA), stating that you are entitled to compensation for a service-connected disability at the 100% rate, or stating you have received a monetary allowance from the VA toward the purchase of a motor vehicle. FORMER PRISONER OF WAR – If you are a former Prisoner of War or spouse of a former Prisoner of War, attach a copy of the Prisoner of War Record of Separation (DD214) or a copy of the honorable discharge; AND any one of the following documents stating Prisoner of War status: A. Any documentary evidence of Prisoner of War status from one of the Armed Forces of the United States. B. Telegram advising family of Prisoner of War status. C. Letter from the War Claims Commission. D. Letter from U.S. Department of Veterans Affairs. CONGRESSIONAL MEDAL OF HONOR – If you have received this award, attach documentary evidence in support of award. SPOUSE OF DECEASED FORMER PRISONER OF WAR – If you are the spouse of a deceased former Prisoner of War who has not previously had Ohio Former Prisoner of War plates, follow the Former Prisoner of War instructions above. Otherwise, enter the existing Prisoner of War plate number here: OWNER INFORMATION OWNER NAME SSN/DLN JOINT OWNER NAME SSN/DLN VETERAN NAME MILITARY BRANCH TELEPHONE NUMBER ADDRESS CITY STATE ODOMETER READING CERTIFICATE OF TITLE NUMBER VEHICLE MODEL VEHICLE COLOR COUNTY VEHICLE YEAR VEHICLE SERIAL NUMBER VEHICLE MAKE ZIP CODE OWNER AFFIRMATION The vehicle described above shall not be used for farm or commercial purposes, unless registered as farm or commercial, as defined under Ohio Revised Code (R.C.) 4501.01 and 4503.04, that my statements are correct, that the vehicle is lawfully entitled to registration for myself/spouse, and that I grant limited Power of Attorney to the Registrar and Deputy Registrar to renew the vehicle registration. Spouses of deceased former Prisoners of War, also affirm that they have not remarried. SIGNATURE OF OWNER DATE X THESE LICENSE PLATES ARE ISSUED WITHOUT VALIDATION STICKERS. PLEASE NOTIFY THE GRATIS UNIT OF ANY CHANGE OF ADDRESS OR VEHICILES. FOR MORE INFORMATION, CALL (614) 752-7518. RETURN DOCUMENTS TO: OHIO BUREAU OF MOTOR VEHICLES, GRATIS UNIT, P.O. BOX 16521, COLUMBUS, OHIO 432166521. WARNING: Any applicant giving false information is subject to prosecution under R.C. 2913.42. Application must be signed by the owner(s) as named on certificate of title. BMV 4507 9/09 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES YOU WILL LOSE YOUR DRIVER LICENSE FOR AT LEAST 90 DAYS IF YOU DRIVE WITHOUT INSURANCE OR OTHER ACCEPTABLE FINANCIAL RESPONSIBILITY COVERAGE In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage. It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage. PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket traffic court appearances and Upon random checks by the Registrar of Motor Vehicles. At all vehicle inspection stops Upon ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license for 90 DAYS on first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of $75.00 first offense, $250.00 for second offense, and $500.00 any additional offense Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS. ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS. IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied). THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. WHEN REQUIRED, PROOF OF COVERAGE MAY BE SHOWN BY ANY OF THE FOLLOWING: AN INSURANCE POLICY showing automobile liability insurance of at least $12,500 bodily injury per person, $25,000 injury two or more persons, and $7,500 property damage AN INSURANCE IDENTIFICATION CARD (same coverage) A SURETY BOND OF $30,000 issued by any authorized surety company or insurance company A BMV BOND SECURED BY REAL ESTATE having equity of at least $60,000 A BMV CERTIFICATE FOR MONEY OR GOVERNMENT BONDS in the amount of $30,000 on deposit with the Ohio Treasurer of State A BMV CERTIFICATE OF SELF-INSURANCE, available only to companies or persons who own at least twenty-six motor vehicles. YOU WILL LOSE YOUR DRIVER LICENSE FOR AT LEAST 90 DAYS IF YOU DRIVE WITHOUT INSURANCE OR OTHER ACCEPTABLE FINANCIAL RESPONSIBILITY COVERAGE In Ohio, it is illegal to drive any motor vehicle without insurance or other financial responsibility (FR) coverage. It is also illegal for any motor vehicle owner to allow anyone else to drive the owner’s vehicle without FR coverage. PROOF OF COVERAGE IS REQUIRED: Whenever a police officer issues a traffic ticket At all vehicle inspection stops Upon traffic court appearances and Upon random checks by the Registrar of Motor Vehicles. ANY DRIVER OR OWNER WHO FAILS TO SHOW PROOF OF INSURANCE OR OTHER COVERAGE WILL: Lose his or her driver license for 90 DAYS on first offense, ONE YEAR on second offense and TWO YEARS on additional offenses Lose his or her license plates and vehicle registration Pay reinstatement fees of $75.00 first offense, $250.00 for second offense, and $500.00 any additional offense Pay a $50.00 penalty for any failure to surrender his or her driver license, license plates, or registration AND Be required to maintain special FR coverage (“High-risk” insurance or equivalent) on file with the Bureau of Motor Vehicles (BMV) for THREE or FIVE YEARS. ONCE THIS SUSPENSION IS IN EFFECT: Any driver or owner who violates the suspension will have his or her vehicle immobilized and his or her license plates confiscated for at least 30 DAYS first offense and 60 DAYS second offense. For third or subsequent offenses, the vehicle will be forfeited and sold and the person will not be permitted to register any motor vehicle in Ohio for FIVE YEARS. IF YOU ARE INVOLVED IN AN ACCIDENT WITHOUT INSURANCE OR OTHER FR COVERAGE: In addition to all the penalties listed above, you may have A SECURITY SUSPENSION for TWO YEARS or more and A JUDGMENT SUSPENSION INDEFINITELY (until all damages have been satisfied). THESE PENALTIES ARE IN ADDITION TO ANY FINES OR PENALTIES IMPOSED BY A COURT OF LAW. WARNING: THESE LAWS DO NOT PREVENT THE POSSIBILITY THAT YOU MAY BE INVOLVED IN AN ACCIDENT WITH A PERSON WHO HAS NO INSURANCE OR OTHER FR COVERAGE. If applying for a driver license or permit, I affirm that I now have insurance or other financial responsibility coverage and that I will not operate any motor vehicle without FR coverage, and that I received an FR coverage notice form. If registering a motor vehicle, I affirm that all owners (or lessees of leased vehicles) now have insurance or other FR coverage and will not operate or permit the operation of this motor vehicle without FR coverage. SIGNATURE DATE X BMV 4507 9/09 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com