83034 - Florida Department of Highway Safety and Motor ...

HSMV 83034 - REV. 09/21 Florida Department OF Highway Safety AND Motor VEHICLES APPLICATION FOR MILI TARY SERVICE-RELATED LI CENSE PLATES SUBMIT APPLI CATI ON TO Y OUR LOCAL COUNTY TAX COLLECTOR'S OFFICE OR LICENSE PLATE A GENT ALL APPLICATIONS FOR MEDAL OF HONOR, SILVER STAR, DISTINGUISHED SERVICE CROSS, NAVY CROSS, AIR FORCE C ROSS, DISTINGUISHED FLYING CROSS, OR WORLD WAR II VETERAN MUST BE SUBMITTED TO THE DIVISION OF MOTORIST SERVICES See Reverse Side of this form for Address, Provisi ons of Law, and Instructions ,hereby certify that I am a legal resident of F lorida, residing at (A ddress) (City) (State) (Zip) and I am the regis tered owner of the following described Motor vehicl e: YEAR MAKE CURRENT LICENSE PLATE NUMBER TITLE NUMBER VEHICLE IDENTIFICATION NUMBER OW NER/LESSEE'S DATE OF BIRTH SEX OWNER/LESSEE'S DL NUMBER OW NER/LESSEE S EMAIL ADDRESS is to certify that I,, am applying (and providing proof of eligibility, as lis ted below) for t he following lic ense plate as indicated:Ex-Prisoner of War Purple Heart Medal of Honor Pearl Harbor Survivor US Paratrooper Operation Iraqi Freedom Operation Enduring Freedom Gold Star Vete ran of US Armed Forces Combat infantry Badge Combat Action Badge Combat Medical Badge Viet nam War Veteran

Proof from the US Government of being a recipient of the Combat Infantry Badge or proof of membership In the Combat Infantrymen’s A ss ociation, In c., or other proof of being a recipient of the Combat Infantry Badg e. Combat Action Bad ge: Proof from the US Government of being a recipient of the Combat Action Badge, or other proof of being a

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  Infantry, 33804

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