Application for

For County Use Only

License No
Disabled Veteran License Plates Mo/Yr of Exp
Texas Department
of Motor Vehicles and/or Parking Placards Date Issued

Instructions
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. Do not mail cash. One vehicle is eligible for a $3 Disabled Veteran (DV)
license plates. Additional vehicles may display a DV license plate; however, registration and local fees will apply.
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 or if you have any questions.

Applicant Information
First Name Middle Name Last Name Suffix (if any)

Address City State ZIP

Email Driver License No. Phone Number

Vehicle – Annual $3 specialty license plate fee applies for the first set of plates only. Otherwise registration and local fees apply.
Vehicle Identification Number Current TX Plate (if any) Year Make Body Style
I I
Vehicle Type:
 Passenger Car (up to 18,000 lbs.)  Truck (up to 18,000 lbs.)  Motor home  Motorcycle/Moped
Parking Placard: Owners of passenger cars, trucks, and motor homes may be issued a disabled parking placard with approval of this
application.
 Check for one disabled parking placard to be issued with the DV plates. The appropriate Vehicle Type above must be indicated.
International Symbol of Access (ISA) on a motorcycle/moped plate: The ISA is available for motorcycle and moped DV plates.
 Check for the ISA to appear on the DV plate. The appropriate Vehicle Type above must be indicated.

Check ONE Plate Design:

 Disabled Veteran plate (standard design)  Disabled Veteran plate with Emblem (select 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 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
 40 percent or more due to amputation of a lower extremity

Agency Address

Name and Title of Certifying Officer

Certifying Officer Signature Date

Certification – State law makes falsifying information a third degree felony.
I, the applicant listed above, meet the eligibility requirements as listed above and am providing proof to that effect.

Signature Date

Form VTR-615 Rev. 12/2019 Form available online at www.TxDMV.gov Page 1 of 3

 Application for Disabled Veteran License Plates and/or Parking Placards
Disabled Veteran Plate with Emblem – Options in lieu of the standard “Disabled Veteran” plate. See “Additional
Requirements” for these plates on page 3, and select a design choice below only if you checked the box on page 1 for “Disabled
Veteran plate with Emblem.”
Circle your specialty plate choice below or enter your choice here:
• 11th Armored Cavalry Regiment • Enduring Freedom Afghanistan Medal
• 36th Infantry Division • Global War on Terrorism Expeditionary Medal
• 173rd Airborne Brigade • Global War on Terrorism Service Medal
• Air Force Cross Medal • Inherent Resolve Campaign Medal
• Air Medal • Korean Defense Service Medal
• Air Medal with Valor • Korean Service Medal
• Airman's Medal • Korean War National Defense Service Medal
• Armed Forces Expeditionary Medal • Kosovo Campaign Medal
• Armed Forces Service Medal • Legion of Merit Medal
• Army Distinguished Service Cross Medal • Marine Corps Expeditionary Medal
• Army of Occupation Medal • Master Army Aviator Badge
• Bronze Star Medal • Medal of Honor, U.S. Air Force
• Bronze Star Medal with Valor • Medal of Honor, U.S. Army
• China Service Medal • Medal of Honor, U.S. Navy
• Coast Guard Medal • Merchant Marine Expeditionary Medal
• Combat Action Badge • Meritorious Service Medal
• Combat Action Medal • Military Outstanding Volunteer Service Medal
• Combat Action Ribbon, U.S. Coast Guard • Navy Cross Medal
• Combat Action Ribbon, U.S. Navy and Marine Corps • Navy Expeditionary Medal
• Combat Infantryman Badge • Navy and Marine Corps Medal
• Combat Medical Badge • Nuclear Deterrence Operations Service Medal
• Commendation Medal, U.S. Air Force • Operation Iraqi Freedom Medal
• Commendation Medal, U.S. Army • Prisoner of War Medal
• Commendation Medal, U.S. Coast Guard • Purple Heart Recipient Medal
• Commendation Medal, Joint Services • Silver Star Medal
• Commendation Medal, U.S. Navy and Marine Corps • Soldier's Medal
• Commendation Medal with Valor, U.S. Air Force • Standard General Issue license plate
• Commendation Medal with Valor, U.S. Army • Tomb Guard
• Commendation Medal with Valor, U.S. Coast Guard • U.S. Air Force
• Commendation Medal with Valor, Joint Services • U.S. Air Force Academy
• Commendation Medal with Valor, U.S. Navy and Marine Corps • U.S. Army
• Defense Meritorious Service Medal • U.S. Coast Guard
• Defense Superior Service Medal • U.S. Coast Guard Academy
• Desert Storm National Defense Service Medal • U.S. Marine Corps
• Desert Storm Southwest Asia Service Medal • U.S. Merchant Marine Academy
• Distinguished Flying Cross Medal • U.S. Military Academy – West Point
• Distinguished Flying Cross Medal with Valor • U.S. Naval Academy
• Distinguished Service Medal, U.S. Air Force • U.S. Navy
• Distinguished Service Medal, U.S. Army • Vietnam Service Medal
• Distinguished Service Medal, U.S. Coast Guard • Vietnam Era - National Defense Service Medal
• Distinguished Service Medal, U.S. Department of Defense • Woman Veteran
• Distinguished Service Medal, U.S. Department of Homeland Security
• Distinguished Service Medal, U.S. Department of Transportation
• Distinguished Service Medal, U.S. Navy

Form VTR-615 Rev. 12/2019 Form available online at www.TxDMV.gov Page 2 of 3

 Application for Disabled Veteran License Plates and/or Parking Placards
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).
• 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.
State law does not allow the ISA on a vehicle weighing more than 18,000 lbs.
Personalization fee will not be refunded once the application is submitted.
1st Choice 2nd Choice 3rd Choice
Vehicle 1

Vehicle 2

I I I 1 1 1

Additional Requirements to Obtain an Emblem Design

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:
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.
36th Infantry Division: You serve or have served in the 36th Infantry Division of the U.S. Army of the Texas Army National Guard.
Enduring Freedom: You participated in Operation Enduring Freedom.
Enduring Freedom Afghanistan: You participated in Enduring Freedom Afghanistan.
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.
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. 12/2019 Form available online at www.TxDMV.gov Page 3 of 3