Application for Disabled Veteran License Plates
and/or Parking Placards
Instructions
For County Use Only
License No
Mo/Yr of Exp
Date Issued
Submit the completed application; payment 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. Do not mail cash. One vehicle is eligible for a $3 specialty license plate fee. Additional vehicles may display a Disabled Veteran license plate; however, registration and local fees will apply.
The license plates may be personalized for an additional $40 fee; make your choice on page 3. 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 for issuance. Contact your county tax assessor-collector if you have questions.
Applicant Information |
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First Name |
Middle Name |
Last Name |
Suffix |
County |
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Address |
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City |
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State |
ZIP |
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Email |
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Driver License No. |
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Phone Number |
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Vehicle 1 - Annual $3 specialty license plate fee applies.
Vehicle Identification Number |
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Current Plate |
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Year |
Make |
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Body Style |
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Empty Weight (lbs.) |
Vehicle Type: Passenger Car |
Truck (up to 18,000 lbs.) |
Motorcycle/Moped |
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Check for a parking placard in addition to the plates |
Check for the International Symbol |
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of Access (ISA) on the plate |
Choose ONE plate design:
Disabled Veteran plate (standard) Disabled Veteran plate with emblem (indicate design choice on page 2)
Vehicle 2 - Annual vehicle registration and local fees apply.
Vehicle Identification Number |
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Current Plate |
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Year |
Make |
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Body Style |
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Empty Weight (lbs.) |
Vehicle Type: Passenger Car |
Truck (up to 18,000 lbs.) |
Motorcycle/Moped |
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Check for a parking placard in addition to the plates |
Check for the International Symbol |
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of Access (ISA) on the plate |
Choose ONE plate design: |
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Disabled Veteran plate (standard) Disabled Veteran plate with emblem (indicate design choice on page 2)
Proof of Eligibility - To be completed by a U.S. Department of Veterans Affairs Regional Office or appropriate service branch.
The records of this agency reflect the following service-connected disability rating for the above named veteran (check one):
50 percent or more 40 percent or more due to amputation of a lower extremity Comment (if any)
Agency __________________________________________ Address _______________________________________________
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Name and Title of Certifying Officer |
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Certifying Officer Signature |
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Date |
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Certification – State law makes falsifying information a third degree felony. |
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I meet the eligibility requirements as listed above and am providing proof to that effect. |
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Signature |
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Date |
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Form VTR-615 Rev. 9/2017 |
Form available online at www.TxDMV.gov |
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Page 1 of 3 |
Disabled Veteran plate with emblem – Options in lieu of the standard “Disabled Veteran” plate. See “Additional Requirements” for these plates on page 3, and choose design choice below only if you checked the box on page 1 for “Disabled Veteran plate with emblem.”
11th Armored Cavalry Regiment
36th Infantry Division
Air Force
Air Force Cross Medal
Air Medal
Air Medal with Valor
Airman's Medal
Armed Forces Expeditionary Medal
Armed Forces Service Medal
Army
Bronze Star
Bronze Star with Valor
Coast Guard
Coast Guard Medal
Combat Action Badge
Combat Action Medal
Combat Action Ribbon Coast Guard
Combat Action Ribbon Navy and Marines
Combat Medical Badge
Combat Infantryman's Badge
Commendation Medal Air Force
Commendation Medal with Valor Air Force
Commendation Medal Army
Commendation Medal with Valor Army
Commendation Medal Coast Guard
Commendation Medal with Valor Coast Guard
Commendation Medal Joint Services
Commendation Medal with Valor Joint Services
Commendation Medal Navy and Marine Corp
Commendation Medal with Valor Navy and Marine Corp
Defense Meritorious Service Medal
Defense Superior Service Medal
Desert Storm National Defense Service Medal
Desert Storm Southwest Asia Service Medal
Distinguished Flying Cross Medal
Distinguished Flying Cross Medal with Valor
Distinguished Service Cross Medal Air Force
Distinguished Service Medal Army
Distinguished Service Medal Coast Guard
Distinguished Service Medal Department of Defense
Distinguished Service Medal Department of Homeland Security
Distinguished Service Medal Navy
Distinguished Service Medal Dept. of Transportation
Global War on Terrorism Expeditionary Medal
Global War on Terrorism Service Medal
Inherent Resolve Campaign Medal
Korean Defense Service Medal
Korean Service Medal
Korean War National Defense Service Medal
Kosovo Campaign Medal
Legion of Merit
Marines
Marine Corp Expeditionary Medal
Merchant Marine Expeditionary Medal
Meritorious Service Medal
Military Outstanding Volunteer Service Medal
Navy
Navy Expeditionary Medal
Navy and Marine Corps Medal
Navy Cross
Operation Enduring Freedom Afghanistan
Operation Iraqi Freedom
Prisoner of War
Purple Heart Medal
Silver Star
Soldier's Medal
Standard General Issue license plate
U.S. Air Force Academy
U.S. Coast Guard Academy
U.S. Merchant Marine Academy
U.S. Military Academy
U.S. Naval Academy
Vietnam Service Medal
Vietnam War Nat’l. Defense Service Medal
Woman Veteran
Form VTR-615 Rev. 9/2017 |
Form available online at www.TxDMV.gov |
Page 2 of 3 |
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 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 personalized 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 a star (use an ampersand “&” to indicate).
•Passenger car and truck plates are limited to six (6) characters total, including punctuation characters.
•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 the International Symbol of Access.
Personalization fee will not be refunded once the application is submitted.
1st Choice |
2nd Choice |
3rd Choice |
Vehicle 1
Vehicle 2
Additional requirements to obtain an emblem design are listed on page 2.
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, or served as indicated below:
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.
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.
Operation Enduring Freedom Afghanistan: You participated in Operation Enduring Freedom Afghanistan.
Operation Iraqi Freedom: You participated in Operation Iraqi Freedom.
Military Academies: You graduated from the listed academy.
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.
Form VTR-615 Rev. 9/2017 |
Form available online at www.TxDMV.gov |
Page 3 of 3 |
