Application for Disabled Veteran License Plates and/or Parking Placards Instructions Submit the completed application and payment in the form of a personal check, money order, or cashier222s check with proof of eligibility to your local county tax assessor-collector222s office. Do not mail cash. One vehicle is eligible for a $3 Disabled Veteran (DV) license plate. 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-collector222s office in three weeks to verify your plates are ready, or if you have any questions. Applicant Information First Name Middle Name Last Name Suffix Address City State ZIP Email Driver License No. Phone Number Vehicle - Annual $3 specialty license plate fee applies for the first set of plates only. Otherwise registration and local fees apply. Vehicle Identification Number Current TX Plate (if any) Year Make Body Style Vehicle Type: Passenger Car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motor home Motorcycle/Moped Parking Placard: Owners of passenger cars, trucks, and motor homes may be issued a disabled parking placard with approval of this application. Check for one disabled parking placard to be issued with the DV plates. The appropriate Vehicle Type above must be indicated. International Symbol of Access (ISA) on a motorcycle/moped plate: The ISA is available for motorcycle and moped DV plates. Check for the ISA to appear on the DV plate. The appropriate Vehicle Type above must be indicated. Ch eck ONE Plate D esign: Disabled Veteran plate (standard design) Disabled Veteran plate with Emblem (indicate design choice on page 2) Proof of Eligibility 226 To be completed by a U.S. Department of Veterans Affairs Regional Office or appropriate service branch. The department will accept either a letter from the U.S. Department of Veterans Affairs certifying the applicant222 s disability percentage, or this section must be completed. The records of this agency reflect the following service-connected disability rating for the above named veteran (check one): 50 percent or more 40 percent or more due to amputation of a lower extremity Name and Title of Certifying Officer Certifying Officer Signature Date Agency Address Certification 226 State law makes falsifying information a third degree felony. I meet the eligibility requirements as listed above and am providing proof to that affect. Signature Date Form VTR-615 Rev. 3/2019 Form available online at www.TxDMV.gov Page 1 of 3 For County Use Only License No Mo/Yr of Exp Date Issued American LegalNet, Inc. www.FormsWorkFlow.com Application for Disabled Veteran License Plates and/or Parking Placards Disabled Veteran plate with E mblem 226 Options in lieu of the standard 223Disabled Veteran224 plate. See 223Additional Requirements224 for these plates on page 3 , and choose design choice below only if you checked the box on page 1 for 223 Disabled Veteran plate with E mblem .224 11th Armored Cavalry Regiment 36th Infantry Division 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 Bronze Star Bronze Star with Valor Coast Guard Medal Combat Action Badge Combat Action Medal Combat Action Ribbon Coast Guard Combat Action Ribbon Navy and Marines Combat Medical Badge Combat Infantryman's Badge Commendation Medal Air Force Commendation Medal with Valor Air Force Commendation Medal Army Commendation Medal with Valor Army Commendation Medal Coast Guard Commendation Medal with Valor Coast Guard Commendation Medal Joint Services Commendation Medal with Valor Joint Services Commendation Medal Navy and Marine Corp Commendation Medal with Valor Navy and Marine Corp 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 Air Force Distinguished Service Medal Army Distinguished Service Medal Coast Guard Distinguished Service Medal Department of Defense Distinguished Service Medal Department of Homeland Security Distinguished Service Medal Navy Distinguished Service Medal Dept. of Transportation 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 Marine Corp Expeditionary Medal Merchant Marine Expeditionary Medal Meritorious Service Medal Military Outstanding Volunteer Service Medal Navy Expeditionary Medal Navy and Marine Corps Medal Navy Cross Operation Enduring Freedom Afghanistan Operation Iraqi Freedom Prisoner of War Purple Heart Medal Silver Star 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. Marines U.S. Merchant Marine Academy U.S. Military Academy U.S. Naval Academy U.S. Navy Vietnam Service Medal Vietnam Era - National Defense Service Medal Woman Veteran Form VTR-615 Rev. 3/2019 Form available online at www.TxDMV.gov Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Application for Disabled Veteran License Plates and/or Parking Placards Personalize Your Plate 226 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 annua l 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 223*224 to indicate), a heart (use an at 223@224 to indicate), and a star (use an ampersand 223&224 to indicate). Personalized plates must include 223DV224 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 223224 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 223%224 to indicate the International Symbol of Access (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. 1st Choice 2nd Choice 3rd Choice Vehicle 1 Vehicle 2 Additional r equirements 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 Korean Demilitarized Zone 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: