Form VTR-420 Rev 03/16 Page 1 of 3Online form at www.TxDMV.gov

For County Use Only

License Number

Mo/Yr of Exp

Date Issued

Application for Military Service License Plates

InstructionsSubmit the completed application, payment (if required) in the form of a personal check, money order or cashier's check, and proof of eligibility to your local county tax assessor-collector's office. Do not mail cash. There is no specialty plate fee. Plate may be personalized for an additional $40 fee, make your selection on page 3. Your annual registration fee must be paid to your local county tax assessor-collector when your plates are issued. NOTE: When the specialty plates are issued, additional fees may be collected to establish a single expiration date for both the specialty plate and the vehicle registration. If you place your order by mail, please contact your county tax assessor-collector’s office in three weeks to verify your plates are ready for issuance. Personalization fees will not be refunded once application is submitted. Contact your county tax assessor-collector if you have any questions.

Last NameMiddle Initial SuffixFirst Name County

Day Phone

Mailing Address City State Zip Code

E-mail

Applicant Information Type or print only

Vehicle 1 Specialty plates are available for the vehicle types listed.Year MakeCurrent TX PlateVehicle Identification Number Body Style Empty Weight (lbs.)

Vehicle Type: Passenger cars and trucks (up to 18,000 lbs.), motorcycles, trailers and travel trailers. Passenger Car Truck Motorcycle/Moped Trailer Travel Trailer

Vehicle 2 Specialty plates are available for the vehicle types listed.Year MakeCurrent TX PlateVehicle Identification Number Body Style Empty Weight (lbs.)

Vehicle Type: Passenger cars and trucks (up to 18,000 lbs.), motorcycles, trailers and travel trailers. Passenger Car Truck Motorcycle/Moped Trailer Travel Trailer

• Texas title and vehicle registration must be in your name. • If the plate is to be registered to a vehicle that is not titled in your name, attach a statement to this application stating that you

have legal right of possession and control of this vehicle at all times. • If you recently filed an application for title, attach a copy of the title application receipt (VTR-500 RTS). • Joint vehicle ownership between you and a spouse is permissible. • Submit a separate application for more than two vehicles. • If the vehicle is leased, attach a photocopy of the lease agreement. • Vehicle is for personal use only.

General Requirements

Form VTR-420 Rev 03/16 Page 2 of 3Online form at www.TxDMV.gov

Application for Military Service License PlatesPlate Type Note: All plates below are available for passenger cars and trucks (up to 18,000 lbs.). Plates available for motorcycles/mopeds are indicated by (M), those available for trailers/travel trailers are indicated by (T).

Combat Action Medal (M)(T)

Combat Action Badge (M)(T)

Combat Action Ribbon, Navy and Marines (M)(T)Combat Action Ribbon, Coast Guard (M)(T)

Combat Infantryman's Badge (M)(T)

Commendation Medal, Air Force (M)(T)

Commendation Medal, Navy and Marines (M)(T)

Commendation Medal, Coast Guard (M)(T)Commendation Medal, Joint Service (M)(T)

Commendation Medal, Army (M)(T)

National Defense Service Medal, Desert Shield/Desert Storm (M)(T)Southwest Asia Service Medal, Desert Shield/Desert Storm (M)(T)Enduring Freedom (M)Enduring Freedom Afghanistan (M)Operation Iraqi Freedom (M)(T)

Korean Service Medal (M)(T)Korean Defense Service Medal (M)(T)

National Defense Service Medal, Korea (M)(T)Marine Corps LeagueUS Air Force Academy (M)US Coast Guard Academy (M)

US Military Academy, West Point (M)US Merchant Marine Academy (M)

US Naval Academy (M)US Paratrooper (M)National Defense Service Medal, Vietnam (M)(T)Vietnam Service Medal (M)(T)Woman Veteran (M)World War II Veteran

Note: Use form VTR-139 For Texas Army National Guard, Texas Air National Guard, 36th Infantry Guard, or Texas State Guard plates.

Eligibility RequirementsBelow are details of Texas' military license plate eligibility requirements. The most common proof document is the DD Form 214, Certificate of Release or Discharge from Active Duty, referred to as a "DD214". For Guard and Reservists, instead of a DD214, a letter from an awarding authority is acceptable. TxDMV will also accept an Officer Record Brief (ORB) or Enlisted Record Brief (ERB) with a copy of your military ID or proof of honorable discharge. Please include proof you are an active member of the United States Armed Forces, a former member with an honorable discharge, proof that you were awarded service medals, or served as follows: • World War II: Either the U.S. or Allied Armed Forces during World War II. • Korea: u In the Armed Forces between June 27, 1950 and July 27, 1954 and received the National Defense Service Medal; or. u In a combat zone in Korea between June 27, 1950, and July 27, 1954 and received the Korean Service Medal; or u In the Korean Demilitarized Zone beginning July 28, 1954, and received the Korean Defense Service Medal. • Vietnam: u In the Armed Forces between January 1, 1961, and August 14, 1974, and received the National Defense Service Medal; or u In 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: u In the Armed Forces between August 2, 1990 and November 30, 1995 and received the National Defense Service Medal; or u In 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. • Operation Iraqi Freedom: You participated in Operation Iraqi Freedom. • Enduring Freedom: You participated in Operation Enduring Freedom. • Enduring Freedom Afghanistan: You participated in Operation Enduring Freedom Afghanistan. • Marine Corps League: You are a member of the Marine Corps League or its Auxiliary. • Military Academies: You graduated from the academy listed. • U.S. Paratrooper: You passed proficiency tests while attached to an airborne unit, the Airborne Department of the U.S. Army

Infantry School, or participated in at least one combat parachute jump. • 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.

State law makes falsifying information on this application a third-degree felony.

Signature of Applicant Date

I meet the eligibility requirements as listed on this form, and am providing proof to that effect.

Form VTR-420 Rev 03/16 Page 3 of 3Online form at www.TxDMV.gov

Application for Military Service License Plates

International Symbol of AccessTo display the International Symbol of Access on your license plate, attach a signed Form VTR-214 to this form to show your eligibility. Contact your county tax assessor-collector if you have questions.

Personalize Your Plate If you would like to personalize your specialty plate, there will be a $40 fee per year, in addition to the annual registration fee.• Show selections exactly as you wish them to appear on your license plates. You may list more than one option in the event the

personalization you have chosen is already issued. • A selection that has already been issued, is deemed offensive or conflicts with the regular license plate numbering system cannot

be approved. • In the blocks below, describe each of your selected personalized letters, numbers, and/or symbols. The available symbols

include: a period, a dash, a blank space, a Texas silhouette (use an asterisk (*)), a heart (use an “at” mark (@)) and a star (use an ampersand (&)). You are not required to use all the spaces provided.

• Passenger car, truck, trailer and travel trailer plates are limited to six (6) letters and numbers, including the International Symbol of Access or punctuation characters.

• U.S. Paratrooper plates are limited to five (5) characters total due to plate design. • Motorcycle/moped plates are limited to four (4) characters total. • The International Symbol of Access counts as two (2) characters. If you are disabled and applying for personalized specialty plates, use a percent sign (%) to indicate the International Symbol of Access.

Personalization fee will not be refunded once application is submitted.

1st Selection 2nd Selection 3rd Selection

Vehicle One

Vehicle Two