Fillable Printable Application For The 100 Year Anniversary License Plate
Fillable Printable Application For The 100 Year Anniversary License Plate
Application For The 100 Year Anniversary License Plate
FORM VTR-100 Rev. 9/2017 Online form available at www.TxDMV.govPage 1 of 1
Application for the
100 Year Anniversary
License Plate
Instructions
Submit the completed application and payment in the form of a personal check, money order, or cashier’s check to your local county tax assessor-
collector’s office. The specialty plate fee is $30 per year in addition to your annual registration fee.Do not mail cash.
NOTE: When the specialty plate is issued, additional fees may be collected to establish a single expiration date for both the specialty plate and
the vehicle registration. If you order online or by mail, please contact your county tax assessor-collector’s office in three weeks to verify your plate is
ready for issuance.The specialty plate feewill not be refunded oncetheapplication has been submitted.
This license plate is a commemorative specialty plate that will be available to order for one year onlystarting on September 1, 2017.Theinitial
one hundred plates issued will receive an alphanumeric pattern beginning with “100.” Contact your county tax assessor-collector if you have any
questions.
Applicant Information– Type or print only
First Name
Middle Initial
Last Name
Suffix
Address
City
State
ZIP
Phone
Email
Current TX Plate
Year
Make
Body Style
Vehicle Type
Passenger car Truck (up to 18,000 lbs.)
General Requirements
•For passenger cars and trucksonly with a gross vehicle weight of 18,000 lbs. or less.
•License plates must be displayed on the front and rear of a qualifying vehiclein accordance with state law.
•This commemorative specialty license plate will be available for a limited period and may not be personalized.
The plate may be renewed each year as long as the registration on the vehicle does not expire.
Certification –State lawmakes falsifying information a third degree felony.
My signature indicates the information above is true and correct.
Signature Date
License No
Mo/Yr of Exp
Date Issued
DepartmentUse Only
