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Fillable Printable Military Veteran Registration Plates - North Carolina

Fillable Printable Military Veteran Registration Plates - North Carolina

Military Veteran Registration Plates - North Carolina

Military Veteran Registration Plates - North Carolina

MVR-33A
Rev 7/2015
Military/Veteran’sRegistrationPlateApplication
ApplicationmustbesubmittedwithsupportingdocumentstoNCDivisionofVeteransAffairspriortosubmittingtoNCDMV
S
ection1Iwouldliketoapply (
)
forthefollowinglicenseplate:
Pleaseselectonlyone(1)plateforeachapplication
**AfghanistanVeteran(suffixAV)‐none **KoreanConflict(suffixKV)‐none
AirMedalRecipient(suffixAM)‐$10.00**LegionofMerit(suffixLM)‐none
*BronzeStarCombatRecipient(SuffixV)‐Free *LegionofValorFree
**BronzeStarRecipient(suffixBS)‐none **PartiallyDisabledVeteran(prefixPD)‐none
*CongressionalMedalofHonor‐Free **PearlHarborSurvivor‐none
**DesertStormVeteran(suffix GV)‐none **PurpleHeartRecipientMotorcycle(suffixPV)‐none
*DisabledVeteran(suffixDV)‐Free **PurpleHeartRecipient(prefixPH)‐none
DistinguishedFlyingCross(suffixFC)‐$10.00 *Silver
StarDisabledVeteran(prefixSD)‐Free
*DistinguishedServiceCross(suffixDC)‐Free *SilverStarRecipient(suffixSS)‐Free
*ExPrisonerofWar‐Free **VietnamEra(suffixVV)‐none
**GoldStarLapelButton(suffixGS)‐none **WaronTerror(suffixWT)‐none
**IraqVeteran(suffixIV)‐none **WorldWarllVeteran(suffixWV)‐none
*Onefreeplateperperson,**Nospecialfee licensefeeisdue
_____FirstinFlightBackground_____FirstinFreedomBackground
WhenapplyingforapersonalizedMilitary/Veteranlicenseplate,pleaseremembertheprefix/suffixrepresentingtheplatewillbe thefirst/lastletters
ontheplate.Personalizedspecialplatechoicemustcontainatleastonealpha character.Thepersonalizedplatechoicecannotbenumbersonly.
Pleasenotetheprefix/suffixfortheplate.Ifyouchoosetopersonalizetheplate,thecostwillbeanadditional$30.00personalizedfee.
Youareallowedfour(4)spacesforapersonalizedmessage____________
THESPECIAL/PERSONALIZEDFEEISANANNUALFEEDUEINADDITIONTOLICENSEFEE
North Carolina Division of Motor Vehicles
3155 Mail Service Center
Raleigh, NC 27699-3155
VA FILE NUMBER
Section3NorthCarolinaDivisionofVeteransAffairs
1315MailServiceCenter
Raleigh,NC276991315
TobecompletedbytheNCDivisionofVeteransAffairspriortosubmittingtoNCDepartmentofMotorVehicles
TherecordsoftheU.S.DepartmentofVeteransAffairsindicatesthattheaboveapplicantqualifiesfor
a
_____________________________________________speciallicenseplate.
(TypeofPlateDesiredfromtheListAbove)
PrintedNameoftheDirectoroftheNCDivisionofVeteransAffairsortheDirector’sDesignee

Si
g
natureoftheDirectoroftheNCDivisionofVeteransAffairsorthe Director’sDesi
g
nee Date
Section2
Name(ToagreewithcertificateofTitle):



FirstMiddleLast


Address


CityStateZipCode


DriverLicense#StateCurrentNCPlateNumber 
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Owner’sCertificateofInsurance
IcertifyforthemotorvehicledescribedabovethatIhavefinancialresponsibilityasrequiredbylaw.
PrintorTypeFullNameofInsuranceCompanyPolicyNumber
AuthorizedinN.C.‐NotAgencyorGroup
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
SIGNATUREOFOWNER DATEOFCERTIFICATION
CONTACTINFORMATION:
 HOMEPHONE:_________________________
 OFFICEPHONE:_________________________
 CELLPHONE:_________________________
VEHICLEIDENTIFICATIONNUMBER
YEAR MAKE BODYSTYLE
VEHICLEINFORMATION:
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