OHIO DEPARTMENT OF PUBLICSAEFTY BUREAU OF MOTOR VEHICLES REQUEST FOR MILITARY TYPE LICENSE PLATES For other types of special plates obtain BMV 4705 Separate request required for each vehicle – PLEASE DO NOT SUBMIT FEES WITH THIS REQUEST PRINT or TYPE name as it appears on the Ohio Certificate of Title. If vehicle is leased, include lessee’s name and address. NAME HOME PHONE ( STREET ADDRESS ) BUSINESS PHONE ( CITY ) STATE OHIO COUNTY DATE OF BIRTH A. CITY OR INCORPORATED VILLAGE Complete if you live inside corporation limits. TITLE NUMBER VEH PUR DATE VEHICLE SERIAL NUMBER YES SOCIAL SECURITY NUMBER B.TOWNSHIP Complete if you live outside corporation limits. CURRENT LICENSE PLATE NUMBER IS THIS A LEASED VEHICLE? ODOMETER O R ZIP CODE VEH YR VEH MAKE BODY TYPE TRUCK G.V.W. CURRENT EXPIRATION DATE (Mo. & Day) IF YES, COMPLETE THE LESSEE INFORMATION. NO LESSEE’S NAME SOCIAL SECURITY NO. OR TAX ID NO. COUNTY STREET ADDRESS CITY STATE ZIP CODE OH IMPORTANT: Check BOXES for type of vehicle and for type of plates requested. Military plates cannot be assigned to trucks in a company name. All plates with special logos are available as stock plates (preassigned numbers only) or as reserved/personalized plates. PASSENGER NONCOMMERCIAL Honorably Discharged Veteran RECREATIONAL VEHICLES MOTOR HOME TRAVEL TRAILER Retired Veteran branch Combat Veteran name of war/conflict branch Military Reservists Active Duty Military Personnel branch branch Pearl Harbor Survivors Purple Heart Veteran Motorcycle National Guard Silver Star Medal Bronze Star Medal National Defense Medal Armed Force Expeditionary Medal INDICATE YOUR CHOICES FOR RESERVED OR PERSONALIZED SPECIAL LICENSE PLATES If you want stock plates (preassigned numbers only), DO NOT write below. The first available choice will be assigned. If your first choice is not available, a substitute assignment will be made when possible. There is a MAXIMUM of 6 characters for license plates with logos including spaces (due to size limitations, a space counts as one character). Leave a box empty to indicate a space for reserved/personalized plates. Dashes, symbols and punctuation marks cannot be used. Inappropriate requests will not be issued. FIRST CHOICE THIRD CHOICE SECOND CHOICE FOURTH CHOICE MAIL THIS REQUEST FORM TO: BMV 4742 10/07 Page 1 of 2 Ohio Bureau of Motor Vehicles Attn: Special Plates Request Form P.O. Box 16521 Columbus, Ohio 43216-6521 FIFTH CHOICE DO NOT SEND FEES WITH THIS FORM SPECIAL INSTRUCTIONS AND FEES ON BACK American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS • • • • • Your request cannot be processed if the Certificate of Title has not yet been issued. The vehicle must be titled or leased in the name of the person qualifying for any of these plates. The military plates listed below may be requested with a personalized message. Part of your current registration fees may be applied toward the purchase of military plates; your billing notice will show all ADDITIONAL fees to process the military plates. BY MAIL: Upon receipt of the signed billing notice, required documents and correct fees, the license plates registration card, validation sticker and county sticker will be mailed to you. AT DEPUTY: Upon receipt of the required documents and correct fees, the deputy will issue you a registration card, validation sticker and county sticker. Your military plates will be mailed to you. Military plates can be registered only to passenger vehicles, noncommercial trucks, and recreational vehicles. Newly titled noncommercial trucks are required to submit a noncommercial trucks affidavit (BMV 5712) with this request form. The affidavit is available at all deputy registrar agencies. Veteran motorcycle plates can be issued to motorcycles only. Fees for license plates are determined by the type of vehicle and the amount of permissive tax (from $0 to $20.00) charged in your place of residence. A $2.00 fee is required for all newly manufactured plates. FEES FOR RESERVED OR PERSONALIZED LICENSE PLATES LISTED BELOW ARE REQUIRED ANNUALLY IN ADDITION TO BASIC REGISTRATION FEES. IF YOU ELECT TO PURCHASE STOCK OR PREMANUFACTURED (NO SPECIFIC NUMBER) LICENSE PLATES, THERE IS NO ADDITIONAL FEE ASSESSED. RESERVED $10.00* Standard manufacturing procedure does not permit a choice of spacing for this type of license plates. LETTERS MAY NOT BE USED IN THE MIDDLE OF NUMBERS. TWO LETTERS ONLY (AA THRU ZZ) THREE LETTERS ONLY (AAA THRU ZZZ) NUMBERS ONLY 28801 THRU 999999 ONE LETTER BEFORE OR AFTER 1 THRU 99999 1A THRU 99999A A1 THRU A99999 FIVE LETTERS ONLY (00AAA) (Motorcycles Only) THREE LETTERS BEFORE OR AFTER 1 THRU 9 AAA1 THRU ZZZ9 1AAA THRU 9ZZZ TWO LETTERS BEFORE OR AFTER 1 THRU 9999 AA1 – ZZ9999 1AA – 9999ZZ ONE LETTER BEFORE AND AFTER 1 THRU 9999 A1A – Z9999Z PERSONALIZED $35.00* Personalized military license plates must contain no less than four letters and no more than six letters or combination of four letters with numbers. Personalized military plates with 5 characters may have one space e.g., MR WWI. HONORABLY DISCHARGED VETERANS or RETIRED VETERANS – Veterans must submit a copy of their DD-214 or equivalent document to verify honorably discharged or retired status from a branch of the United States Armed Forces. MILITARY RESERVISTS OR NATIONAL GUARD - Reservists or National Guard must submit a statement on letterhead indicating branch or service, signed by their commanding officer. National Guard Plates are issued only to current members of the Ohio Guard. COMBAT VETERANS - Discharged veterans must submit a copy of their DD-214 or equivalent document to verify the location and period of service. Active duty service members must have served in the country of Saudi Arabia or Kuwait during Operation Desert Storm or Operation Desert Shield, in Panama, Grenada or Lebanon during the invasion, the Vietnam or Korean conflict or during World War II or World War I. PEARL HARBOR SURVIVORS - Certification must be submitted from the Pearl Harbor Survivors Association (PHSA). PURPLE HEART - A DD-214 showing you received a Purple Heart must be submitted to qualify for these plates. ACTIVE DUTY MILITARY PERSONNEL – Active duty applicants must submit a certifying letter (on letterhead) from the individual’s commanding officer or show a military identification card (only if identification reads “Active Duty”). BRONZE STAR MEDAL – Applicant must submit a copy of his/her DD-214 showing award of a Bronze Star Medal or a copy of a Bronze Star Certificate (or permanent orders) with the applicant’s name identified as the recipient of the specific military medal. SILVER STAR MEDAL – Applicant must submit a copy of his/her DD-214 showing award of a Silver Star Medal or a copy of a Silver Star Certificate (or permanent orders) with the applicant’s name identified as the recipient of the specific military medal. ARMED FORCES EXPEDITIONARY MEDAL – Applicant must submit a copy of his/her DD-214 showing and Armed Forces Expeditionary Medal was awarded or a letter from the commanding officer verifying that he or she is entitled to said award. NATIONAL DEFENSE MEDAL – Applicant must submit a copy of his/her DD-214 showing receipt of the award or a copy of the award certificate with the applicant’s name identified as the recipient of the specific military medal or proof of active duty status either with an identification card that specifically states “active duty” (cards issued after April 1, 2005 will not indicate status so applicant must provide a letter) or a letter from a commanding office indicating that the applicant is in active duty status, as the award has been given to all service members since September 11, 2001 and will continue until further determined. VETERAN MOTORCYCLE – Veteran must submit a copy of his/her DD214 showing an Honorable Discharge or a copy of the certificate of Honorable Discharge or evidence of disability retirement, or a copy of a certificate of retirement or any equivalent documentation such as a military I.D. card marked retired. BMV 4742 10/07 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com