VTR-615: Texas Application for Disabled Veteran License Plates and/or Parking Placards

Fill in First Name, Middle Name, Last Name and Suffix (if any), then Address, City, State and ZIP, then Email, Phone Number and Driver License State and No.

State law makes falsifying information a third-degree felony.

Please include your Driver License number (DL #) or Identification Card number (ID #) on this application.

The DL or ID # provided on this application will be partially shown on the placard issued.

Your signature below indicates that you are (check one): the person with the disability listed above (enter your DL or ID #), or the administrator or manager of an institution licensed to transport persons with disabilities defined under Transportation Code, Section 681.0032 (enter the DL or ID #).

Institutions, facilities, and residential retirement communities licensed under Chapter 242, 246, or 247 of the Health and Safety Code must list a facility ID # issued by the agency.

Annual $3 specialty license plate fee applies for the first set of plates only. Otherwise, registration and local fees apply.

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.

Fill in Vehicle Identification Number, Current TX Plate (if any), Year, Make and Body Style.

Under Vehicle Type, check Passenger Car (up to 18,000 lbs.), Truck (up to 18,000 lbs.), Motor home or Motorcycle/Moped.

Common mistake: Check ONE Plate Design: DV license plate (standard design), DV license plate with Emblem (select design choice on page 4), DV ISA license plate, or DV ISA license plate with Emblem (select design choice on page 4).

DV license plates displaying the ISA may be issued to persons with a permanent disability who meet the eligibility requirements below (limit two sets of plates).

Common mistake: State law does not allow the ISA on a vehicle weighing more than 18,000 lbs.

ISA on a motorcycle/moped plate: The ISA is available for motorcycle and moped DV license plates.

Parking Placard: Owners of passenger cars, trucks, and motor homes who meet the eligibility requirements for a DV ISA license plate may be issued a disabled parking placard with approval of this application.

The appropriate Vehicle Type must be indicated on page 1.

Check for two disabled parking placards to be issued without a set of DV ISA license plates. Check for one disabled parking placard to be issued with one set of DV ISA license plates. Check for two disabled parking placards to be issued with two sets of DV ISA license plates.

Persons with Disabilities Parking Placard: Submit the completed application with proof of eligibility to your local county tax assessor-collector's office or the county tax assessor-collector's office where you are seeking medical treatment.

A parking placard may be issued to Disabled Veterans with a permanent disability who meet the eligibility requirements and who are issued DV ISA license plates. There is no fee for a placard issued to a person with a permanent disability.

Limit two (2) placards for Disabled Veterans with no DV ISA license plates. Limit two (2) placards for Disabled Veterans with two sets of DV ISA license plates.

Common mistake: To obtain Disabled parking placards, the signature of a licensed medical professional must be notarized on page 3 if an original prescription is not submitted.

Proof of Eligibility is to be completed by a U.S. Department of Veterans Affairs Regional Office or appropriate service branch. The Texas Department of Motor Vehicles will accept either a letter from the U.S. Department of Veterans Affairs certifying the applicant's disability percentage, or this section must be completed.

The records of this agency reflect the following service-connected disability rating for the veteran named above (check one): 50 percent or more, or 40 percent or more due to amputation of a lower extremity.

The lines for the certifying officer are Agency, Address, Name and Title of Certifying Officer, Certifying Officer Signature and Date.

I, the applicant listed on page 1, meet the eligibility requirements as listed above and am providing proof to that effect, or I am making application on behalf of a person with a disability as indicated in the Identification Statement.

Sign on the Signature line and fill in the Date.

Transportation Code, Section 681.001(2) defines a disability as a condition in which a person has: (a) mobility problems that substantially impair the person's ability to ambulate; (b) visual acuity of 20/200 or less in the better eye with correcting lenses; or (c) visual acuity of more than 20/200 but with a limited field of vision in which the widest diameter of the visual field subtends an angle of 20 degrees or less.

Transportation Code, Section 681.001(5) defines a mobility problem as one that substantially impairs a person's ability to ambulate, and the person: (a) cannot walk 200 feet without stopping to rest; (b) cannot walk without the use of or assistance from an assistance device, including a brace, cane, crutch, another person or a prosthetic device; (c) cannot ambulate without a wheelchair or similar device; (d) is restricted by lung disease to the extent that the person's forced respiratory expiratory volume for one second, measured by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 millimeters of mercury on room air at rest; (e) uses portable oxygen; (f) has a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association; (g) is severely limited in the ability to walk because of an arthritic, neurological, or orthopedic condition; (h) has a disorder of the foot that, in the opinion of a physician licensed to practice medicine in this state or in a state adjacent to this state, limits or impairs the person's ability to walk; or (i) has another debilitating condition that, in the opinion of a physician licensed to practice medicine in this state or a state adjacent to this state, or authorized by applicable law to practice medicine in a hospital or other health facility of the Veterans Administration, limits or impairs the person's ability to walk.

Disability Statement: To be completed by a Licensed Medical Professional. An original prescription is acceptable proof if not providing a written statement or completing the Disability Statement.

A Licensed Medical Professional is defined as a physician, podiatrist, optometrist, or qualifying physician's assistant or advanced practice nurse as defined in Chapter 301, Occupations Code.

At least one of the following conditions must be met: licensed in Texas, Arkansas, Louisiana, New Mexico, or Oklahoma; or must practice medicine in a U.S. military installation based in Texas; or must practice medicine in a hospital or health facility of the U.S. Department of Veterans Affairs.

Licensed Medical Professional: On the line after I certify that, write the Printed Name of Person with a Disability or Mobility, and check the box before permanent disability, as defined above.

The lines for the Licensed Medical Professional are Printed Name of Licensed Medical Professional, Professional License Number, Date, Signature of Licensed Medical Professional, Mailing Address, City, State and ZIP.

The Notary section is only for placards and must be completed by a notary if an original prescription is not submitted.

Notary: On this date, the above named licensed medical professional appeared before me so that I could witness his or her signature.

The notary's lines are State of, County of, Notary Public and My commission expires, next to the STAMP HERE box.

DV License Plate with Emblem: Options in lieu of the standard Disabled Veteran plate. See Additional Requirements for these plates on page 5 and select a design choice on page 4 only if you checked the box on page 2 for DV license plate with Emblem.

Circle your specialty plate choice on page 4 or enter your choice here.

Personalize Your Plate: 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 annual registration fee.

Show personalization(s) 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.

Common mistake: 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, under 1st Choice, 2nd Choice and 3rd Choice.

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 a star (use an ampersand “&” to indicate).

Personalized plates must include “DV” 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 (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.

Common mistake: The DV ISA and DV ISA plate with military Emblem are not eligible for personalization.

Common mistake: The personalization fee will not be refunded once the application is submitted.

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 (the list is on page 4), 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 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.

Borinqueneers Congressional Gold Medal: You served in World War I, World War II, or the Korean War while assigned to the 65th Infantry Regiment.

Enduring Freedom: You participated in Operation Enduring Freedom.

Enduring Freedom Afghanistan: You participated in Enduring Freedom Afghanistan.

Operation Freedom's Sentinel: You serve or have served in the U.S. Armed Forces and participated in Operation Freedom's Sentinel.

Operation Iraqi Freedom: You participated in Operation Iraqi Freedom.

Prisoner of War: You must provide an official U.S. government document or certification from the U.S. Department of Veterans Affairs certifying or identifying you as a former prisoner of war.

Military Academies: You graduated from the listed academy (the list is on page 4).

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.

U.S. Paratrooper Master: You completed U.S. Paratrooper Master Qualifications and participated in a minimum of 65 jumps, including 25 jumps with combat equipment.

U.S. Paratrooper Senior: You completed U.S. Paratrooper Senior Qualifications and participated in a minimum of 30 jumps, including 15 jumps with combat equipment.

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.

This form is the Application for Disabled Veteran License Plates and/or Parking Placards.

The applicant listed on page 1 signs the Certification. The Certifying Officer signs in the Proof of Eligibility section, and the Texas Department of Motor Vehicles will accept either a letter from the U.S. Department of Veterans Affairs certifying the applicant's disability percentage, or this section must be completed. A Licensed Medical Professional signs the Disability Statement, which is to be completed by a Licensed Medical Professional; an original prescription is acceptable proof if not providing a written statement or completing the Disability Statement. The Notary section is only for placards and must be completed by a notary if an original prescription is not submitted.

Submit the completed application and payment in the form of a personal check, money order, or cashier's check with proof of eligibility to your local county tax assessor-collector's office.