License No

Mo/Yr of Exp

Date Issued

Application for Military Service License Plates

For County Use Only

Instructions Submit 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. There is no specialty plate fee.

Your annual registration fee must be paid to your local county tax assessor-collector when your plates are issued. NOTE: When the specialty plate is issued, additional fees may be collected to establish a single expiration date for both the new specialty plate and the vehicle registration. The license plates may be personalized for an additional $40 fee; make your choice on page 2. Do not mail cash. The personalization fee will not be refunded once the application is submitted.

If you order by mail, please contact your county tax assessor-collector’s 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 (if any) County

Mailing Address City State ZIP

Email Phone Number

Vehicle 1 Vehicle Identification Number Current TX Plate Year Make Body Style

Empty Weight (lbs.) Passenger Car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motorcycle/Moped Trailer

Vehicle 2 Vehicle Identification Number Current TX Plate Year Make Body Style

Empty Weight (lbs.) Passenger Car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motorcycle/Moped Trailer

General Requirements • 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 copy of the lease agreement.• Vehicle is for personal use only.

Certification – State law makes falsifying information a third degree felony. I, the applicant listed above, meet the eligibility requirements as listed on page 3 of this application and am providing proof to that

effect.

Signature Date

Form VTR-420 Rev. 12/2019 Form available online at www.TxDMV.gov Page 1 of 3

http:www.TxDMV.gov

Circle your specialty plate choice below or enter your choice here:

Application for Military Service License Plates Plate Type – All plates are available for passenger cars and trucks (up to 18,000 lbs.). Plates available for motorcycles/mopeds are indicated by (M); plates available for trailers are indicated by (T).

•••••••••••••••••••••••••

1st Choice 2nd Choice 3rd Choice

11th Armored Cavalry Regiment (M) (T) 173rd Airborne Brigade Armed Forces Expeditionary Medal (M) (T) Armed Forces Service Medal (M) (T) China Service Medal (M) (T) Combat Action Badge (M) (T) Combat Action Medal (M) (T) Combat Action Ribbon, U.S. Coast Guard (M) (T) Combat Action Ribbon, U.S. Navy and Marine Corps (M) (T) Combat Infantryman Badge (M) (T) Combat Medical Badge (M) (T) Commendation Medal, U.S. Army (M) (T) Commendation Medal, U.S. Air Force (M) (T) Commendation Medal, U.S. Coast Guard (M) (T) Commendation Medal, Joint Services (M) (T) Commendation Medal, U.S. Navy and Marine Corps (M) (T) Commendation Medal with Valor, U.S. Army (M) (T) Commendation Medal with Valor, U.S. Air Force (M) (T) Commendation Medal with Valor, U.S. Coast Guard (M) (T) Commendation Medal with Valor, Joint Services (M) (T) Commendation Medal with Valor, U.S. Navy and Marine Corps (M) (T) Desert Shield/Storm National Defense Service Medal (M) (T) Desert Shield/Storm Southwest Asia Service Medal (M) (T) Enduring Freedom (M) Enduring Freedom Afghanistan (M)

• Global War on Terrorism Expeditionary Medal (M) (T) • Global War on Terrorism Service Medal (M) (T) • Inherent Resolve Campaign Medal (M) (T) • Korea Veteran - National Defense Service Medal • Korean Defense Service Medal (M) (T) • Korean Service Medal (M) (T) • Kosovo Campaign Medal (M) (T) • Marine Corps Expeditionary Medal (M) (T) • Marine Corps League • Master Army Aviator Badge • Merchant Marine Expeditionary Medal (M) (T) • Military Outstanding Volunteer Service Medal (M) (T) • Navy Expeditionary Medal (M) (T) • Nuclear Deterrence Operations Service Medal • Operation Iraqi Freedom (M) (T) • Tomb Guard (M) (T) • U.S. Air Force Academy (M) • U.S. Coast Guard Academy (M) • U.S. Merchant Marine Academy (M) • U.S. Military Academy – West Point (M) • U.S. Naval Academy (M) • U.S. Paratrooper (M) • Vietnam Service Medal (M) (T) • Vietnam Veteran - National Defense Service Medal (M) • Woman Veteran (M) • World War II Veteran

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 (if required).

• 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 pe rsonalized 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 “*” to indicate), a heart (use an at “@” to indicate), and astar (use an ampersand “&” to indicate).

• Passenger car, truck, and trailer plates are limited to six (6) characters total, including punctuation characters. • U.S. Paratrooper plates for cars and trucks are limited to five (5) characters total due to the plate design. • Motorcycle/moped plates are limited to four (4) characters total, including punctuation characters. • The International Symbol of Access (ISA) “ ”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 “%” to indicate the ISA.

Personalization fee will not be refunded once the application is submitted.

Vehicle 1

Vehicle 2

Form VTR-420 Rev. 12/2019 Form available online at www.TxDMV.gov Page 2 of 3

http: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 Application for Persons with Disabilities Parking Placard and/or License Plate (Form VTR-214) to this application to show your eligibility. Contact your county tax assessor-collector’s office if you have questions.

Eligibility Requirements • Active members must provide a copy of their military ID and proof they served as indicated or are a recipient of the medal

being applied for, such as an Officer Record Brief or Enlisted Record Brief. • Former members must provide proof of their honorable discharge and proof that they are a recipient of the award, such as a

DD214. World War II: You served in the U.S. or Allied Armed Forces during World War II. 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 Republic of Korea or the contiguous water out 12 nautical miles 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: • the Armed Forces between August 2, 1990, and November 30, 1995, and received the National Defense Service

Medal; or • 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. 11th Armored Cavalry Regiment: You serve or have served in the 11th Armored Cavalry Regiment of the U.S. Army. Enduring Freedom: You participated in Operation Enduring Freedom. Enduring Freedom Afghanistan: You participated in Operation Enduring Freedom Afghanistan. Operation Iraqi Freedom: You participated in Operation Iraqi Freedom. Marine Corps League: You are a member of the Marine Corps League or its Auxiliary. Military Academies: You graduated from the listed academy. Tomb Guard: You serve or have served in the Third United States Infantry Regiment as a guard for the Tomb of the Unknown Soldier and are awarded the Guard, Tomb of the Unknown Soldier Identification Badge. U.S. Paratrooper: You passed proficiency tests while attached to an airborne unit or 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 (use Form VTR-139 for Texas Army National Guard, Texas Air National Guard, 36th Infantry Guard, or Texas State Guard plates).

Form VTR-420 Rev. 12/2019 Form available online at www.TxDMV.gov Page 3 of 3

http:www.TxDMV.gov

License No: MoYr of Exp: Date Issued: First Name: Middle Name: Last Name: Suffix if any: County: Mailing Address: City: State: ZIP: Email: Phone Number: Vehicle Identification Number: Current TX Plate: Year: Make: Body Style: Empty Weight lbs: Vehicle Identification Number_2: Current TX Plate_2: Year_2: Make_2: Body Style_2: Empty Weight lbs_2: Date: Circle your specialty plate choice below or enter your choice here: Vehicle 2 1st Choice: Vehicle 1 1st Choice: Vehicle 1 2nd Choice: Vehicle 1 3rd Choice: Vehicle 2 2nd Choice: Vehicle 2 3rd Choice: Check Box1: OffCheck Box 2: OffCheck Box3: OffCheck Box4: OffCheck Box5: OffCheck Box6: OffCheck Box7: OffCheck Box8: Off