First Name Middle Name Last Name Suffix County

Mailing Address City State ZIP

Email Phone Number

Empty Weight (lbs.)

Empty Weight (lbs.)

Vehicle Identification Number Current TX Plate Year Make Body Style

Date

Application for Military Service License Plates

For County Use Only

License No

Mo/Yr of Exp

Date Issued

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. Contact your county tax assessor-collector if you have questions. Applicant Information

Vehicle 1

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

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

Passenger Car 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 thatyou 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 meet the eligibility requirements as listed on page 3 of this application and am providing proof to that effect.

Signature Form VTR-420 Rev. 9/2017 Form available online at www.TxDMV.gov Page 1 of 3

11th Armored Cavalry Regiment (M) (T) Armed Forces Expeditionary Medal (M) (T) Armed Forces Service Medal (M) (T) Combat Action Badge (M) (T) Combat Action Medal (M) (T) Combat Action Ribbon, Coast Guard (M) (T) Combat Action Ribbon, Navy & Marines (M) (T) Combat Infantryman’s Badge (M) (T) Combat Medical Badge (M) (T) Commendation Medal, Army (M) (T) Commendation Medal, Air Force (M) (T) Commendation Medal, Coast Guard (M) (T) Commendation Medal, Joint Service (M) (T) Commendation Medal, Navy & Marines (M) (T) Commendation Medal with Valor, Army (M) (T) Commendation Medal with Valor, Air Force (M) (T) Commendation Medal with Valor, Coast Guard (M) (T) Commendation Medal with Valor, Joint Service (M) (T) Commendation Medal with Valor, Navy & Marines (M) (T) Enduring Freedom (M) Global War on Terrorism Expeditionary Medal (M) (T) Global War on Terrorism Service Medal (M) (T) Inherent Resolve Campaign Medal (M) (T) Korean Defense Service Medal (M) (T) Korean Service Medal (M) (T)

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). Korea Veteran – National Defense Service Medal Kosovo Campaign Medal (M) (T) Marine Corps League Marine Corps Expeditionary Medal (M) (T) Merchant Marine Expeditionary Medal (M) (T) Military Outstanding Volunteer Service Medal (M) (T) National Defense Service Medal, Desert Shield/Storm (M) (T) National Defense Service Medal, Korea (M) (T) National Defense Service Medal, Vietnam (M) (T) Navy Expeditionary Medal (M) (T) Operation Iraqi Freedom (M) (T) Operation Enduring Freedom Afghanistan (M) Southwest Asia Service Medal, Desert Shield/Storm (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)

atrooper (M) U.S. Par Vietnam Veteran – National Defense Service Medal (M) Vietnam Service Medal (M) (T) 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 optionin 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 numberingsystem cannot be approved.

• Enter your desired personalized letters, numbers, and/or symbols in the blocks below. The available symbols include: aperiod, a dash, a blank space, a Texas silhouette (use an asterisk “*” to indicate), a heart (use an at “@” to indicate),and a star (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 “ ”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 theInternational Symbol of Access.

Personalization fee will not be refunded once the application is submitted. 1st Choice 2nd Choice 3rd Choice

Vehicle 1

Vehicle 2

Form VTR-420 Rev. 9/2017 Form available online at www.TxDMV.gov Page 2 of 3

Application for Military Service License Plates International Symbol of Access To 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 they served as indicated, or are a recipient of the medal being applied for, 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 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:

• the Armed Forces between Aug. 2, 1990, and Nov. 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.

Enduring Freedom: You participated in Operation Enduring Freedom. Operation 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. 11th Armored Cavalry Regiment: You serve or have served in the 11th Armored Cavalry Regiment of the U.S. Army. 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, 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. 9/2017 Form available online at www.TxDMV.gov Page 3 of 3