Missouri Form 4601 PDF Details

Delving into the Missouri 4601 form uncovers a comprehensive application process designed for Missouri military personnel seeking personalized license plates. This form serves as a testament to the state's recognition of its veterans and active military members, offering various customization options to honor their service. The application process meticulously requires the inclusion of personal information, vehicle details, and specific military service credentials to ensure eligibility. It categorizes plates into numerous military honors and services, ranging from the Air Force to combat recognition, including distinguished medals and veteran status. Moreover, the form highlights the necessity of adhering to legal truthfulness, indicating significant penalties for false statements. Special provisions cater to disabled veterans, incorporating the option for accessibility symbols upon presenting medical proof. Additionally, applicants encounter a structured fee system, dependent on their selected plate category, which goes hand-in-hand with a specific document submission guideline to validate their service and entitlement. This comprehensive approach not only personalizes the recognition system but also ensures a dignified acknowledgement within the vehicular realm of public life, fostering a deep sense of pride and remembrance among Missouri's military community.

QuestionAnswer
Form NameMissouri Form 4601
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmo form plate, form 4601, missouri form personalized, mo personalized

Form Preview Example

Form

4601

Application for Missouri Military Personalized License Plates

 

Step 1

Any false statement in this application is a violation of the law

and may be punished by fine or imprisonment or both.

Name must appear as shown on vehicle title

Owner’s Name

Street, RR, or P.O. Box Number

City

State

ZIP Code

 

 

 

 

 

 

 

 

 

Daytime Phone Number

 

Current Plate Number

(__ __ __)__ __ __-__ __ __ __

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Please select which category of license plate you need)

r Passenger

r Recreational Vehicle (motor home)

r Beyond Local 6 Truck

r Local 6 Truck (limited to a 50 mile radius)

r Beyond Local 12 Truck

r Local 12 Truck (limited to a 50 mile radius)

r Beyond Local 18 Truck

r Local 18 Truck (limited to a 50 mile radius)

r Beyond Local 24 Truck

r Local 24 Truck (limited to a 50 mile radius)

r Motorcycle

r Motortricycle

r Autocycle

rSelect here to add this symbolto your plate.

(Physician’s Statement for Disabled Person’s License Plates, Form 1776 is required. See back for more information.)

Type of license plate to be issued (some license plates require proof of eligibility - see reverse)

For all plates listed as “Stock,” the Missouri Department of Revenue will select your license plate configuration.

Step 2

Submit fee shown below with this application. r Air Force ($15)

r Air Medal ($15)

r Armed Forces Expeditionary Medal (Stock - $15)

r Armed Forces Expeditionary Medal ($15) r Army ($15)

r Bronze Star (Stock - $15)

Valor r Yes r No

r Bronze Star ($15) Valor r Yes r No

r Civil Air Patrol ($15)

r Coast Guard ($15)

r Combat Action Badge ($15)

r Combat Action Ribbon ($15)

r Combat Infantryman (Stock - $15) r Combat Infantryman ($15)

r Combat Medic (Stock - $15) r Combat Medic ($15)

r Congressional Medal of Honor (No Fee)

r Disabled Veteran r Stock r Personalized r Initial Set (No Fee) r Additional Set ($15)

rDistinguished Flying Cross (Stock - $15)

rDistinguished Flying Cross ($15)

rFormer POW (Stock - No Fee)

rFormer POW (No Fee)

rGulf War - Desert Storm or Shield (Stock - $15)

rGulf War - Desert Storm or Shield ($15)

rKorea Defense Service Medal ($15)

rKorean War (Stock - $15)

rKorean War ($15)

rLegion of Merit Medal (Stock - $15)

rLegion of Merit Medal ($15)

rMarine Corps ($15)

rMarine Corps League ($15)

rMerchant Marine ($15)

rMilitary Award Placard (No Fee) *See info. on reverse side.

rNational Guard ($15)

rNavy ($15)

rNavy Cross ($15)

rOperation Enduring Freedom ($15)

rOperation Iraqi Freedom ($15)

r Operation Noble Eagle ($15)

r Pearl Harbor Survivor (Stock - $15)

r Pearl Harbor Survivor ($15)

r Purple Heart r Stock r Personalized

r Initial Set (No Fee)

r Additional Set

r Retired Military (No Personalization Fee)

Branch of Service ___________________

r Silver Star (Stock - $15)

r Silver Star ($15)

r Some Gave All (Gold Star) - ($15)

r U.S. Veteran ($15)

r Veteran of Foreign Wars (VFW) ($15)

r Vietnam Veteran (Stock - $15)

r Vietnam Veteran ($15)

r Wartime Disabled ($15)

r We Shall Not Forget (Gold Star) -

(No Personalization Fee)

r Woman Veteran ($15)

r World War II (Stock - $15)

r World War II ($15)

Step 3

Personalized plate choices (complete only if applying for personalized plates. Please include more than one choice.)

 

 

Plate Design

 

 

 

 

Total number of characters allowed. A dash, space, or an apostrophe counts as one character.

 

 

 

 

 

 

(Only one dash, one space, or one apostrophe is allowed.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plates with emblem

 

 

 

 

 

 

 

 

 

6

 

 

 

 

 

Note: The Missouri Department of Revenue will not issue license plates that

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

contain any letters, numbers, or a combination of letters and numbers which are

Plates with emblem and

 

 

 

 

 

 

 

 

4

 

 

 

 

 

obscene, profane, patently offensive or contemptuous of a racial or ethnic group,

wheelchair symbol

 

 

 

 

 

 

 

 

 

 

 

 

 

 

offensive to good taste or decency, or would present an unreasonable danger to

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Autocycle/motorcycle/motortricycle

 

 

 

 

 

5

 

 

 

 

 

the health or safety of the applicant, or other users of streets and highways, or

plates with emblem

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the public in any location where the vehicle with such plate may be found. The

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Autocycle/motorcycle/motortricycle

 

 

 

 

 

3

 

 

 

 

 

Missouri Department of Revenue will not issue plates that conflict with the regular

 

 

 

 

 

 

 

 

 

 

license numbering system.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

with emblem and wheelchair symbol

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vehicle Plate Will

Year

 

Make

 

 

 

 

 

Model

 

 

 

 

VIN Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Be Attached To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Choice

 

 

 

Second Choice

 

 

 

Third Choice

 

 

Fourth Choice

 

 

Fifth Choice

 

 

 

 

Sixth Choice

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of what the configuration

 

Description of what the configuration

 

 

Description of what the configuration

 

Description of what the configuration

 

Description of what the configuration

 

Description of what the configuration

above stands for.

 

 

above stands for.

 

 

above stands for.

 

above stands for.

 

above stands for.

 

above stands for.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Step 4

Must be completed by all applicants. These license plates will not be mailed. Indicate name of license office where plates are to be picked up.

Office

 

Office Number

I hereby certify under penalty of perjury that all information regarding this request is true and accurate and

 

 

 

 

 

is made without intent to defraud and that all statutory requirements for personalized or special license

 

 

 

 

 

plates have been met. I also acknowledge that, if the requested configuration is already issued for a

 

 

 

 

 

vehicle I own, I must surrender those plates when I pick up the new plates bearing that configuration.

Street

City

Signature of Owner

X

 

 

 

 

 

 

 

 

 

 

or Applicant

 

 

 

 

 

 

 

 

 

 

 

 

 

Form 4601 (Revised 08-2020)

Applications must be completed, signed, and submitted with the fee noted on the front of the application. The annual fee indicated on the application is in addition to the regular registration fee set by law and is payable upon renewal. Depending on the type of license plates requested, additional documentation may be required as noted below. Make check or money order (do not send cash) payable to the Missouri Department of Revenue and forward with this application to: Missouri Department of Revenue, Motor Vehicle Bureau, Personalized License Plate Section, PO Box 569, 301 West High St, Room 370, Jefferson City MO 65105-0569. The Missouri Department of Revenue may electronically resubmit checks returned for insufficient or uncollected funds. If you have questions regarding this application, call (573) 526-3669 or visit http://dor.mo.gov/mvdl.

You must renew your personalized military license plates within 60 days of expiration to ensure the military personalized plates are held in your name.

Step 1: Fill in the name exactly as it is shown on the title of the vehicle to which you intend to register this license plate. Fill in your current address, daytime telephone number, and license plate number that you currently have on the vehicle.

Check the category of license plate that belongs on the vehicle to which you intend to register this plate. Local truck plates are limited to a 50 mile radius. You may add the disabled person symbol to any plates. You must also submit an original signed physician’s statement for disabled person’s license plates (Form 1776) from an advance practice registered nurse, licensed physician, chiropractor, physician’s assistant, podiatrist, or optometrist must be submitted that states the disability is permanent. The physician’s statement is valid for 90 days after completion by an authorized medical professional.

Step 2: Check the type of license plate you would like issued. Please note that some license plates require additional documentation or requirements which are noted below. Military license plates are issued only to those vehicles titled in Missouri.

Air Force, Army, Coast Guard, Marine Corps, Merchant Marine, National Guard, and Navy Plates: The applicant must submit a copy of his or her current military identification card, or one of the seven (7) documents to show honorable discharge listed at the bottom of this page.

Air Medal, Bronze Star, Combat Action Badge, Combat Action Ribbon, Combat Infantryman, Combat Medic, Distinguished Flying Cross, Korea Defense Services Medal, Silver Star, Armed Forces Expeditionary Medal, and Legion of Merit: The applicant must submit a copy of one of the seven (7) documents listed at the bottom of this page, which must be properly completed, signed, and list the citation or decoration the applicant received that corresponds with the type of plate being requested.

Civil Air Patrol Plates: The applicant must submit a $15.00 (Minimum) original Emblem Use Authorization Statement from the organization.

Congressional Medal of Honor Plates: The applicant must submit a letter from the United States Department of Veteran Affairs verifying the applicant was awarded the Congressional Medal of Honor.

Disabled Veteran Plates: The applicant must submit a statement from the United States Department of Veteran Affairs no more than one year from the date of application stating their disability is service connected. If requesting the wheelchair accessibility symbol, the applicant must also submit an original signed Physician’s Statement for Disabled Person License Plates (Form 1776) from an advance practice registered nurse, licensed physician, chiropractor, physician’s assistant, podiatrist, or optometrist must be submitted that states the disability is permanent. The physician’s statement is valid for 90 days after completion by an authorized medical professional. Limited to one set at no fee, per owner. Additional set(s) of plates issued shall be subject to regular registration and required personalization fees.

Former POW Plates: The applicant must submit a copy of former POW membership card, or a statement from the United States Department of Veterans Affairs or the United States Department of Defense, or one of the seven (7) documents as listed at the bottom of this page stating that he or she is a former prisoner of war .

Gulf War (Desert Storm or Shield), Korean War, Operation Enduring Freedom, Operation Iraqi Freedom, Operation Noble Eagle, Vietnam Veteran, and World War II Plates: The applicant must submit one of the seven (7) documents listed at the bottom of this page, which must be properly completed, signed, show honorable discharge, and list the citations or decorations he or she received for serving in the designated war or conflict.

Marine Corps League Plates: The applicant must submit a copy of Marine Corps League membership card verifying he or she is currently a member in good standing of the Marine Corps League.

Military Award Placard: Veteran medal recipients of the Air Force Cross, Bronze Star, Coast Guard Cross, Congressional Medal of Honor, Distinguished Flying Cross, Distinguished Service Cross, Former POW, Navy Cross, Purple Heart, or Silver Star, may obtain this placard by presenting proof the veteran has been awarded such medal.

Navy Cross: The applicant must submit a copy of his or her certificate of release or discharge from active duty (Form DD214) or correction to Form DD214 (Form DD215) verifying the applicant received the Navy Cross decoration.

Pearl Harbor Survivor Plates: The applicant must submit one of the following:

1.A copy of his or her discharge papers issued by the United States Armed Forces verifying that he or she served in the United States Armed Forces on December 7, 1941, and was stationed on the Hawaiian Island of Oahu or other related military installation during the enemy attack;

2.Verification from the United States Armed Forces that he or she is a Pearl Harbor Survivor; or

3.A copy of the identification card issued by the Pearl Harbor Association, Inc. verifying he or she is a Pearl Harbor Survivor.

Purple Heart Plates: The applicant must submit a copy of one of the seven (7) documents listed at the bottom of this page, which must be properly completed, signed, and list the Purple Heart as one of the citations or decorations the applicant received, or a copy of military order of the Purple Heart membership card.

Retired Military Plates: The applicant must submit proof of retired status from a particular branch of the United States Armed Forces.

Some Gave All Plates: The applicant who has had an immediate family member die in the line of duty while serving in the United States Armed Forces. The applicant must submit a $25.00 (minimum) original Emblem Use Authorization Statement from the Veterans of Foreign Wars, or the Department of Revenue .

U.S. Veteran (U.S. Vet) Plates: The applicant must submit proof of military eligibility indicating the applicant was honorably discharged from the military.

Veterans of Foreign Wars (VFW) Plates: The applicant must submit a $25.00 (minimum) original Emblem Use Authorization Statement from the organization.

Wartime Disabled Plates: You must submit a copy of your Disabled American Veteran (DAV) membership identification card and a copy of a current photo identification card with this application.

We Shall Not Forget (Gold Star): Eligible applicants are any immediate family member, including stepsiblings or stepchildren, of a member of the military who was a resident of Missouri and killed in the line of duty. The applicant must provide the requested configuration of the plate in Step 3 on the front of this application. The requested configuration cannot be in use and must contain the initials of the family member killed in the line of duty followed by a three letter description of the applicant’s relationship to the family member. Please provide multiple options.

Woman Veteran: The applicant must submit one of the seven (7) documents listed at the bottom of this page, which must be properly completed, signed and, if discharged, showing honorable discharge.

Acceptable documentation as noted above includes:

1.

Enlisted Record and Report of Separation (Form WD AGO 53-55);

5.

Official Discharge Order from the United States Armed Forces;

2.

General Orders;

6.

Report of Separation and Record of Service (Form NGB 22); or

3.

Certificate of Release or Discharge from Active Duty (Form DD214);

7.

Current Military Identification Card

4.

Correction to Form DD214 (Form DD215);

 

 

Indicate more than one personalized license plate choice. You may use a combination of letters and numbers. Please print clearly using all capital letters.

Step 3: Signs and symbols cannot be used except for one space, one dash, or one apostrophe. Space limitations are noted on the front of the application.

Please print capital letters and numbers as follows:

Indicate the license office name and number where license plates are to be picked up. The office name and number can be located at

Step 4: http://dor.mo.gov/mvdl/offloc/. Sign the application.

You will receive a notification letter when your license plates have been sent to the license office you indicated on the front of this application. Please allow up to six to eight weeks after the license plates are ordered for the notification letter to arrive.

Form 4601 (Revised 08-2020)

Mail to: Motor Vehicle Bureau

 

Visit

P.O. Box 569

Phone: (573) 526-3669

http://dor.mo.gov/motorv/plates/

Jefferson City, MO 65105-0569

E-mail: mvbmail@dor.mo.gov

for additional information.

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Guidelines on how to prepare how to missouri form license plate portion 1

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p e t S, Autocyclemotorcyclemotortricycle, and Plates with emblem of how to missouri form license plate

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3. The following part is about Vehicle Plate Will Be Attached To, First Choice, Second Choice, Third Choice, Fourth Choice, Fifth Choice, Sixth Choice, Description of what the, Description of what the, Description of what the, Description of what the, Description of what the, Description of what the, p e t S, and Must be completed by all - complete all these blanks.

Filling out section 3 in how to missouri form license plate

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