Military License Plate Application

1 1DR 2002 (08/03/21)COLORADO DEPARTMENT OF REVENUED ivision of Motor VehiclesVehicle Services License Plate 42-3-213 & 42-3-218(3) Military License plates may be issued to a truck that does not exceed sixteen thousand pounds empty weight, a passenger vehicle, a motorcycle, or a non-commercial or recreational vehicle unless otherwise specified. Military License plates are issued through the print on demand process, after meeting the required qualification and payment of applicable taxes and fees the License Plate will be mailed to your mailing address on your motor vehicle must complete all sections. Failure to complete all sections will result in the Application being returned and delay the issuance of the selected License 1 Last NameFirst NameMiddle InitialLegal AddressCounty of ResidenceCityStateZIPD aytime Phone NumberMailing Address (if different from the above Legal Address)CityStateZIPE mail Address or Mobile Phone Number for Text Messaging (optional)Section 2 License Plate Type Requested (applicant s name must be listed on the vehicle registration) (Check Only One) FPassenger (includes trucks that do not exceed 16,000 lbs, passenger cars, non-commercial or recreational vehicles, or motor home FStandard License Plate FPerson with Disability (PWD) License Plate * FMotorcycle** FStandard License Plate FPerson with Disability (PWD))

2 License Plate * * A completed DR 2219 Persons with Disabilities Parking Privileges Application must be included with this Application ** Motorcycle allowed for all Plate types except National GuardApplicant and Vehicle QualificationsVehicle Qualifications Proof of Insurance Proof of Passing Emissions (if applicable) Proof of OwnershipApplicant Qualifications Applicant must meet the selected Military License Plate type qualifications (see Plate Type Qualifications section) If PWD, applicant must meet PWD requirements listed on the DR 2219 Continued on Page 22 Military License Plate Application (cont d)DR 2002 (08/03/21)Section 3 QUALIFIED EXEMPT Military License Plates (see Plate Type Qualification section)If qualified, the applicant may be issued ONE of the below License plates exempt all ownership taxes and registration fees (sale/use tax not exempt) FAir Force Cross FDistinguished Service Cross FNavy Cross FSilver Star FDisabled Veteran FFormer Prisoner of War FPearl Harbor Survivor FDistinguished Flying Cross FMedal of Honor FPurple HeartQUALIFIED Military License Plates (see Plate Type Qualification section) FBronze Star FKorean War Veteran FSubmarine Service Air Force Army Special Forces FVeteran of Afghanistan War FVeteran of Operation Desert Shield/Storm FBronze Star for Valor FNational Guard Army Coast Guard navy FVeteran of Iraq War FWWII FHonorably Discharged Veteran FNavy Seals Army 10th Mountain Division Marine Corps Woman Veteran FVietnam VeteranFallen Service Member Military License Plates (see Plate Type Qualification section) FFallen Air Force (Airman) FFallen Marines (Marine) FFallen Army (Soldier) FFallen Coast Guard (Guardsman) FFallen navy (Sailor)

3 No Qualification Military License Plates (see Plate Type Qualification section) F4th Infantry Division FNORAD FCivil Air Patrol FUSS Colorado SubmarineSection 4I certify, under penalty of perjury, that the above statements are true and accurate to the best of my of ApplicantDate3 Plate Type Qualifications4th Infantry Division42-3-213(20), Qualifies: A person who supports the Army 4th Infantry DivisionProof: None requiredAir Force Cross42-3-213(10)(c)(III), Qualifies: A natural person who has been awarded the Air Force Cross medalProof: Copy of DD 214 form issued by the Government or Military order awarding the applicant the Air Force Cross medalBronze Star42-3-213(14)(a), Qualifies: A natural person who has been awarded the Bronze Star medalProof: Copy of DD 214 form issued by the Government or Military order awarding the applicant the Bronze Star medalBronze Star for Valor42-3-213(14)(b), Qualifies: A natural person who has been awarded the Bronze Star medal with V for valor distinctionProof: Copy of DD 214 form issued by the Government or Military order awarding the applicant the Bronze Star medal with V for valor distinctionCivil Air Patrol42-3-213(27), Qualifies: A natural person who supports the Civil Air PatrolProof: None requiredDisabled Veteran42-3-213(5), Qualifies.

4 A natural person who has received an honorable discharge, or discharged LGBT veteran, of the Armed Services and who has established such rights to benefits under the provision s of Public Law 663, 79th Congress, as amended, and Public Law 187, 82nd Congress, as amended, or is a veteran of the Armed Forces who incurred a disability and who is, at the date of such Application , receiving compensation from the Veterans Administration or any branch of the Armed Forces for a fifty percent or more, service-connected, permanent disability, or for loss of use of one or both feet or one or both hands, or for permanent impairment or loss of vision in both eyes that constitutes virtual or actual blindnessProof: Copy of DD 214 form issued by the Government or other discharge documents issued by the Armed Services and an eligibility letter from the Veterans Affairs stating all of the below: The veteran has a 50% or greater percentage of disability; and The disability is service connected.

5 And The disability is permanentDistinguished Flying Cross42-3-213(25), Qualifies: A natural person who has been awarded a Distinguished Flying Cross medalProof: Copy of DD 214 form issued by the Government or Military order awarding the applicant the Distinguished Flying Cross medalDistinguished Service Cross42-3-213(10)(c)(II), Qualifies: A natural person who has been awarded the Distinguished Service Cross medalProof: Copy of DD214 form issued by the Government or Military order awarding the applicant the Distinguished Service Cross medalFallen Air Force (Airman)42-3-213(15), Qualifies: A current or past spouse, child, sibling, grandparent,or parent of service member who died in the line of duty while serving in the Armed ForcesProof: Copy of Services member s DD 214, Service Record, Report of Casualty (DD 1300), officially issued documents, or death certificate and proof that the applicant is the current or past spouse, child, sibling, grandparent,or parent of the service memberFallen Army (Soldier)42-3-213(15), Qualifies: A current or past spouse, child, sibling, grandparent,or parent of service member who died in the line of duty while serving in the Armed ForcesProof: Copy of Services member s DD 214, Service Record, Report of Casualty (DD 1300), officially issued documents, or death certificate and proof that the applicant is the current or past spouse, child, sibling, grandparent, or parent of the service memberFallen Coast Guard (Guardsman)42-3-213(15), Qualifies.

6 A current or past spouse, child, sibling, grandparent,or parent of service member who died in the line of duty while serving in the Armed ForcesProof: Copy of Services member s DD 214, Service Record, Report of Casualty (DD 1300), officially issued documents, or death certificate and proof that the applicant is the current or past spouse, child, sibling, grandparent, or parent of the service memberFallen Marines (Marine)42-3-213(15), Qualifies: A current or past spouse, child, sibling, grandparent, or parent of service member who died in the line of duty while serving in the Armed ForcesProof: Copy of Services member s DD 214, Service Record, Report of Casualty (DD 1300), officially issued documents, or death certificate and proof that the applicant is the current or past spouse, child, sibling, grandparent, or parent of the service memberDR 2002 (08/03/21)4 Plate Type Qualifications (cont d)Fallen navy (Sailor)42-3-213(15), Qualifies: A current or past spouse, child, sibling, grandparent,or parent of service member who died in the line of duty while serving in the Armed ForcesProof: Copy of Services member s DD 214, Service Record, Report of Casualty (DD 1300), officially issued documents, or death certificate and proof that the applicant is the current or past spouse, child, sibling, grandparent, or parent of the service memberFormer Prisoner of War42-3-213(3), Qualifies.

7 A natural person who, while serving in the Armed Forces, was incarcerated by an enemy of the united states during a period of conflict with the united StatesProof: Copy of discharge papers indicating that the applicant was incarcerated by an enemy of the united states during a period of conflict with the united StatesHonorably Discharged Veteran42-3-213(4), Qualifies: A natural person who has received an honorable discharge, or discharged LGBT veteran, or is retired from a branch of the Armed ServicesProof: Copy of DD 214 form issued by the Government or other documents that demonstrate that the applicant is honorably discharged or retiredKorean War Veteran42-3-213(9), Qualifies: A natural person who was a member of the Armed Forces between June 27, 1950, and January 31, 1955 Proof: Copy of DD 214 form issued by the Government or other Military documents that indicate the dates the applicant was in the Armed ForcesMedal of Honor42-3-213(7), Qualifies: A natural person who has been awarded a Medal of Honor medalProof: Copy of DD 214 form issued by the Government or letter of verification from the appropriate branch of the Armed Forces that the applicant has been awarded a Medal of Honor medalNational Guard42-3-218, Qualifies: A natural person who is an active or retired member of the Colorado National GuardProof: Form prepared by the Department of Military and Veterans Affairs verifying the applicants active or retired statusNavy Cross42-3-213(10)(c)(I), Qualifies: A natural person who has been awarded the navy Cross medalProof.

8 Copy of DD 214 form issued by the Government or Military order awarding the applicant the navy Cross medalNavy SEALs42-3-213(26), Qualifies: A natural person who has received an honorable discharge, or discharged LGBT veteran, is retired, or is an active or reserve member of the united states navy SEALsProof: Copy of DD 214 form issued by the Government and a certification from the UDT/SEAL Association, Inc., the Rocky Mountain Chapter of the UDT/SEAL Association, Inc., or a successor organization indicating that the applicant has an honorable discharge from, is retired from, or is an active or reserve member of the navy SEALsNORAD42-3-213(19), Qualifies: Any person who wishes to commemorate the North American Aerospace Defense Command s fiftieth anniversaryProof: None requiredPearl Harbor Survivor42-3-213(6), Qualifies: Any natural person who was a member of the Armed Forces on December 7, 1941; was on station on December 7, 2914, during the hours of 7:55 to 9:45 Hawaii time at Pearl Harbor, the island of Oahu, or off-shore at a distance not to exceed three miles therefrom; received an honorable discharge, or discharged LGBT veteran, from the Armed Forces.

9 And holds a current membership in a national organization of survivors of the attack on Pearl HarborProof: Copy of DD 214 form issued by the Government or other discharge documents issued by the Armed Services demonstrating the applicant meets the requirements listed under who qualifies abovePurple Heart42-3-213(2), Qualifies: A natural person who has been awarded a Purple Heart for wounds received in combat at the hands of an enemy of the united StatesProof: Copy of DD 214 form issued by the Government or letter of verification from the appropriate branch of the Armed Forces indicating the applicant was awarded the Purple Heart medalSilver Star42-3-213(10)(c)(IV), Qualifies: A natural person who has been awarded the Silver Star medalProof: Copy of DD 214 form issued by the Government or Military order awarding the applicant the Silver Star medalSubmarine Service42-3-213(3)Who Qualifies: A natural person who is an honorably discharged, discharged LGBT veteran, retired, reserve, or active member of the Submarine Service of the united states NavyProof: Copy of DD 214 form issued by the Government or other evidence demonstrating the applicant meets the requirements in who qualifies Air Force42-3-213(17), Qualifies: A natural person who has received an honorable discharge, discharged LGBT veteran, is retired, or is an active or reserve member or any component of the Air ForceProof: Copy of DD 214 form issued by the Government or other evidence demonstrating the applicant meets the requirements in who qualifies Army42-3-213(12), Qualifies.

10 A natural person who is an honorably discharged, or discharged LGBT veteran, retired, reserve, or active member of the ArmyProof: Copy of DD 214 form issued by the Government or other evidence demonstrating the applicant meets the requirements in who qualifies Army 10th Mountain Division42-3-213(29), Qualifies: A natural person who was honorably discharged, discharged LGBT veteran, retired, reserve, or active member of th