Fillable Printable Military Veteran Registration Plates - North Carolina

Military Veteran Registration Plates - North Carolina

MVR-33A

Rev 7/2015

Military/Veteran’sRegistrationPlateApplication

ApplicationmustbesubmittedwithsupportingdocumentstoNCDivisionofVeteransAffairspriortosubmittingtoNCDMV

ection1Iwouldliketoapply(



)

forthefollowinglicenseplate:

Pleaseselectonlyone(1)plateforeachapplication

**AfghanistanVeteran(suffixAV)‐none**KoreanConflict(suffixKV)‐none

AirMedalRecipient(suffixAM)‐$10.00**LegionofMerit(suffixLM)‐none

*BronzeStarCombatRecipient(SuffixV)‐Free*LegionofValor–Free

**BronzeStarRecipient(suffixBS)‐none**PartiallyDisabledVeteran(prefixPD)‐none

*CongressionalMedalofHonor‐Free**PearlHarborSurvivor‐none

**DesertStormVeteran(suffix GV)‐none **PurpleHeartRecipientMotorcycle(suffixPV)‐none

*DisabledVeteran(suffixDV)‐Free**PurpleHeartRecipient(prefixPH)‐none

DistinguishedFlyingCross(suffixFC)‐$10.00*Silver

StarDisabledVeteran(prefixSD)‐Free

*DistinguishedServiceCross(suffixDC)‐Free*SilverStarRecipient(suffixSS)‐Free

*Ex‐PrisonerofWar‐Free**VietnamEra(suffixVV)‐none

**GoldStarLapelButton(suffixGS)‐none**WaronTerror(suffixWT)‐none

**IraqVeteran(suffixIV)‐none**WorldWarllVeteran(suffixWV)‐none

*Onefreeplateperperson,**Nospecialfee–licensefeeisdue

_____FirstinFlightBackground_____FirstinFreedomBackground

WhenapplyingforapersonalizedMilitary/Veteranlicenseplate,pleaseremembertheprefix/suffixrepresentingtheplatewillbe thefirst/lastletters

ontheplate.Personalizedspecialplatechoicemustcontainatleastonealpha character.Thepersonalizedplatechoicecannotbenumbersonly.

Pleasenotetheprefix/suffixfortheplate.Ifyouchoosetopersonalizetheplate,thecostwillbeanadditional$30.00personalizedfee.



Youareallowedfour(4)spacesforapersonalizedmessage____________



THESPECIAL/PERSONALIZEDFEEISANANNUALFEEDUEINADDITIONTOLICENSEFEE



North Carolina Division of Motor Vehicles

3155 Mail Service Center

Raleigh, NC 27699-3155

VA FILE NUMBER

Section3NorthCarolinaDivisionofVeteransAffairs

1315MailServiceCenter

Raleigh,NC27699‐1315

TobecompletedbytheNCDivisionofVeteransAffairspriortosubmittingtoNCDepartmentofMotorVehicles

TherecordsoftheU.S.DepartmentofVeteransAffairsindicatesthattheaboveapplicantqualifiesfor

a



_____________________________________________speciallicenseplate.

(TypeofPlateDesiredfromtheListAbove)



PrintedNameoftheDirectoroftheNCDivisionofVeteransAffairsortheDirector’sDesignee





Si

natureoftheDirectoroftheNCDivisionofVeteransAffairsortheDirector’sDesi

neeDate

Section2

Name(ToagreewithcertificateofTitle):





FirstMiddleLast



Address



CityStateZipCode



DriverLicense#StateCurrentNCPlateNumber

‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐

Owner’sCertificateofInsurance

IcertifyforthemotorvehicledescribedabovethatIhavefinancialresponsibilityasrequiredbylaw.



PrintorTypeFullNameofInsuranceCompanyPolicyNumber

AuthorizedinN.C.‐NotAgencyorGroup



SIGNATUREOFOWNERDATEOFCERTIFICATION



CONTACTINFORMATION:

HOMEPHONE:_________________________

OFFICEPHONE:_________________________

CELLPHONE:_________________________



VEHICLEIDENTIFICATIONNUMBER



YEARMAKEBODYSTYLE

VEHICLEINFORMATION: