Vtr 615 Form – Fill Out and Use

APPLICATION

DISABLED VETERAN LICENSE PLATES

VTR-615 (Rev. 5/2004) DHT # 142453

***FOR DEPARTMENT USE ONLY***

Vehicle 1 – Plate # IssuedDateVehicle 2 – Plate # IssuedDate

APPLICANT

Name of Owner

Daytime Phone (

)

(as shown on current registration receipt)

Area Code

Mailing Address

City

State

Zip Code

Texas County of Residence

Drivers License No.

VEHICLE 1 - FEE $3.00 – ATTACH FEE TO COMPLETED APPLICATION

Current TX

Body

License Plate:

Year:

Make:

Style:

Vehicle

Title

Identification No:

Document No:

Empty Weight:

PASSENGER

TRUCK

MOTORCYCLE

VEHICLE 2

REGULAR REGISTRATION FEE AND OTHER APPLICABLE FEES (PAID AT THE COUNTY)

Current TX

Body

License Plate:

Year:

Make:

Style:

Vehicle

Title

Identification No:

Document No:

Empty Weight:

PASSENGER

TRUCK

MOTORCYCLE

I, the undersigned, state that I am a resident of the State of Texas and receive compensation from the Federal Government as a result of a service-connected disability. My disability rating is at least 50 percent or at least 40 percent due to amputation of a lower extremity. I hereby authorize the Department of Veteran Affairs or Appropriate Branch of the Armed Forces to release information from their records necessary to verify these facts.

Signature of Veteran or Surviving Spouse

Date

TO BE COMPLETED BY THE DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE

OR APPROPRIATE SERVICE BRANCH

In lieu of completing this section, TxDOT will accept a letter from the Department of Veterans Affairs certifying to the applicant’s disability percentage. The records of this office reflect the following service-connected disability rating for the above named veteran:

A. 50 percent or more

B. 40 percent or more due to amputation of a lower extremity

C. No record

D. Other comments by certifying officer

Name of Agency	Address
Signature of Certifying Officer	Title	Date

ADDITIONAL INFORMATION

To qualify for Disabled Veteran License Plates, an applicant must:

(a)Be a Texas resident;

(b)Be a veteran of the United States Armed Forces;

(c)Have a service-connected disability of at least 50 percent or at least 40 percent due to the amputation of a lower extremity;

(d)Now be receiving compensation from the Federal Government as a result of such disability; and

Texas title must be in the applicant’s name before application for Disabled Veteran License Plates can be approved. If an application for title in the applicant’s name has recently been filed, please attach a copy of the VTR-500 RTS receipt.

(e)Registration of the vehicle must be in the name of the disabled veteran or surviving spouse. Joint ownership between veteran and spouse is permissible. If the vehicle is leased, a copy of the lease agreement must accompany the application.

(f)Vehicle must be used for applicant’s personal use only.

(a)Two sets of plates may be obtained by an applicant for either a motorcycle, passenger car, or a light truck having a manufacturer’s rated carrying capacity of two (2) tons or less.

(b)A copy of current proof of financial responsibility such as a liability insurance card, policy, etc., the completed application, and the $3.00 fee must be submitted with this application for the first vehicle only.

(c)When the application is received and approved, the first set of plates will be mailed to the applicant. The second set of license plates is the regular registration fee and other applicable fees. The plates will be mailed to the applicant’s county of residence. The applicant will be notified when the plates are mailed to the county. The applicant must provide proof of financial responsibility for the second vehicle to the county tax assessor- collector’s office.

Surviving Spouse:

The surviving spouse of a person who would be eligible for Disabled Veteran specialty license plates is entitled to continue to register one vehicle for as long as the spouse remains unmarried.

Parking Privileges:

Vehicles displaying Disabled Veteran License Plates may park in disabled parking spaces that are not designated for “Blue Placard Parking Only.” However, if a BLUE Disabled Person Identification Placard is also displayed, the vehicle may park in parking spaces designated “Blue Placard Parking Only.”

Application for a Disabled Person Identification Placard may be made by submitting an Application for Disabled Person Identification Placard and/or Disabled Person License Plate (Form VTR-214) to the county tax assessor-collector’s office.

Organization:

An organization that owns a motor vehicle, regardless of registration classification or carrying capacity, used exclusively for the transportation, without charge, of disabled veterans with service-connected disabilities, may apply for Disabled Veteran License Plates. A statement, by the Veterans County Service Officer of the county in which the vehicle is registered or by the Department of Veterans Affairs verifying the organizations eligibility, is required.

DO NOT MAIL CASH. Please remit PERSONAL CHECK, MONEY ORDER, OR CASHIER’S CHECK, payable to the

Texas Department of Transportation.

SEND WITH FEE AND PROOF OF FINANCIAL RESPONSIBILITY TO:

TEXAS DEPARTMENT OF TRANSPORTATION

VEHICLE TITLES AND REGISTRATION DIVISION (SPB)

AUSTIN, TX 78779-0001

Check our web site www.dot.state.tx.us for a complete listing of specialty plates that are available.

Questions regarding your application should be directed to the Special Plates Branch at 512/374-5010.

WARNING! TRANSPORTATION CODE, §502.410 PROVIDES THAT FALSIFYING INFORMATION ON ANY REQUIRED STATEMENT OR APPLICATION IS A THIRD-DEGREE FELONY.