I certify that I meet all eligibility requirements to have the special registration plate as indicated above issued to me. In addition, my signature below herebycertifies under penalty of law that the information contained herein is TRUE AND CORRECT. WARNING: Falsification to authorities is a misdemeanor of thethird degree punishable by a fine up to $2,500 and/or imprisonment up to 1 year (18 Pa.C.S. Section 4904[b]).

MV-150V (7-17)

APPLICATION FOR U.S. MILITARY VETERAN REGISTRATION PLATE For Department Use Only

Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104

This application may only be used for a vehicle owned or co-owned by a veteran or service member who served or is serving in theArmed Forces of the United States. Check (4) the applicable block below. NOTE: If your vehicle does not have current registration and you are applying for registrationin addition to the military registration plate, please refer to the instructions on the reverse side of this application.

The following registration plates may ONLY be used on a passenger car or truck with a registered gross weight of not more than14,000 pounds. These registration plates require a $21 fee, provided the vehicle has current registration:q KOREAN WAR VETERAN (G8) q PERSIAN GULF WAR VETERAN (H3) q U.S. NAVY VETERAN (DI)q U.S. AIR FORCE VETERAN (DF) q U.S. ARMY VETERAN (DH) q VETERAN (43) q U.S. COAST GUARD VETERAN (DG) q U.S. MARINE CORPS VETERAN (DJ) q VIETNAM WAR VETERAN (M2)q WORLD WAR II VETERAN (67) q U.S. MERCHANT MARINE (HN)

The following registration plate may ONLY be used on a motorcycle. This registration plate requires a $21 fee, provided themotorcycle has current registration:q VETERAN MOTORCYCLE (Z8)

APPLICANT INFORMATION

Title Number Vehicle Identification Number

VEHICLE INFORMATIONC

E APPLICANT SELF-CERTIFICATION and SIGNATURE

MILITARY INFORMATION

A

B

NOTE: In conjunction with replacement of your registration plate, you will receive one registration card. If additional registration cards are desired, the fee is $2 for each card. Number of Duplicate Registration Cards Requested @ $2 each _________.

Registration Plate Number Expiration Month Yr. Registered Gross Weight (if applicable) Date:

Last Name First Name Middle Name PA DL/Photo ID# Date of Birth

Branch of Service Dates of Active Service Service Number

MO/YR TO MO/YR

Co-Owner Last Name First Name Middle Name PA DL/Photo ID# Date of Birth

Street Address City State Zip Code Telephone Number

D OPTIONAL PERSONALIZATION (NOTE: Additional $104 Fee Required.)

FIRST CHOICE

Personalized U.S. Military Veteran registration plate choices may contain up to FIVE letters or numbers in combination. Pre-printed letterconfigurations or designated letter(s) appear on personalized registration plates based on the type of plate requested. Please see thereverse side of this application for additional information. Only one hyphen or space is permitted as part of the available spaces forpersonalization. No other special characters are available. Please use capital letters and print clearly. NOTE: The Korean War Veteran and theWorld War II Veteran registration plates cannot be personalized at this time.

THIRD CHOICESECOND CHOICE

www.dmv.pa.gov

Signature of Applicant Date

Signature of Co-Applicant Date

NOTE: When requesting a numeric character of zero, please show as "Ø" instead of the alpha character "O." Since this is an electronically fillable form,after printing the form, please be sure any zero is marked with a "/."

To renew your vehicle’s registration in conjunction with this application, you must complete and attach your vehicle renewal applicationor Form MV-140, “Request for Registration,” and a check or money order made payable to the Commonwealth of Pennsylvania, for theappropriate registration renewal fee in addition to the appropriate registration plate fee.

A U.S. Military registration plate cannot be duplicated. If your registration plate is lost, stolen or defaced, you will need to reapply for a U.S.Military registration plate by completing this application and submitting with the appropriate fees. Should you need an immediate replacementregistration plate, please complete and submit Form MV-44, “Application for Duplicate Registration Card, Replacement of Registration Plateor Weight Class Sticker,” and submit a fee of $11. A standard registration plate will be issued until the replacement military registration platecan be provided.

ELIGIBILITY REQUIREMENTS 1. AKorean War Veteran registration plate applicant must submit a legible photocopy of Form DD214, "Separation Papers or Discharge Papers,"

or one of the following, which indicates the applicant served in Korea anytime during the period of June 27, 1950, through Jan. 31, 1955: u A copy of the Korean Service Medal Award. u Statement of Service in Korea during the period of time listed above from the St. Louis, Missouri, Records Center at:

Department of Army, National Personnel Records Center, 9700 Page Blvd., St. Louis, Missouri 63132. 2. A Persian Gulf War Veteran registration plate applicant must submit a legible photocopy of Form DD214, "Separation Papers or

Discharge Papers," or one of the following, which indicates service in the Southwest Asia Theater of Operations between August 2, 1990to the present:

u A copy of the citation for the Southwest Asia Service Medal awarded between Aug. 2, 1990, through Nov. 30, 1995, or, u A copy of the citation for the Armed Forces Expeditionary Medal awarded between Dec. 1, 1995, to the present or, when the

applicant is currently on active duty, a statement of service from the applicant’s commanding officer verifying duty in the Southwest Asia Theater.

3. A U.S. Air Force Veteran, U.S. Army Veteran, U.S. Coast Guard Veteran, U.S. Marine Corps Veteran and U.S. Navy Veteranregistration plate applicant must submit a legible photocopy of Form DD214, "Separation Papers or Discharge Papers," which indicateshonorable discharge from the Armed Forces or a legible photocopy of the front and back of their DD2(RET), "United States UniformedServices Identification Card (Retired)," or a legible photocopy of the front and back of their DD2S(RET), "United States UniformedServices Identification Card (Retired)."

4. A Vietnam War Veteran registration plate applicant must submit a legible photocopy of Form DD214, "Separation Papers or DischargePapers," which indicates one of the following medals was awarded:

u A copy of the citation for the Armed Forces Expeditionary Medal if applicant served in Vietnam between July 1,1958, to July 3,1965, or,

u A copy of the citation for the Vietnam Service Medal if applicant served in Vietnam between July 3,1965, through March 28, 1973.

5. A Veteran or a Veteran Motorcycle registration plate applicant must submit a legible photocopy of Form DD214, "Separation Papersor Discharge Papers,” or a legible photocopy of the front and back of their DD2(RET), "United States Uniformed Services IdentificationCard (Retired)," or a legible photocopy of the front and back of their DD2S(RET), "United States Uniformed Services Identification Card(Retired)," which indicates honorable discharge from the Armed Forces of the U.S. or a Reserve component of the Armed Forces. NOTE:National Guard Reservists will need to submit Form NGB22, “Report of Separation and Record of Service," or a legible photocopy of thefront and back of their DD2(RES), "Armed Forces of the United States Geneva Conventions Identification Card (Reserve)," or a legiblephotocopy of the front and back of their DD2S(RESRET), "United States Uniformed Services Identification Card (Reserve Retired)."

6. AWorld War II Veteran registration plate applicant must submit a legible photocopy of Form DD214, "Separation Papers or DischargePapers," which indicates service anytime during the period of Dec. 7, 1941, through Dec. 31, 1946.

7. A U.S. Merchant Marine registration plate applicant must submit a legible photocopy of Form DD214, “Separation Papers or DischargePapers," which indicates service as a Merchant Marine anytime during World War II, the Korean War, the Vietnam Conflict, or any ofthe Gulf Wars, including Operation Desert Storm, Operation Iraqi Freedom and Operation Desert Shield.

IF PERSONALIZING YOUR REGISTRATION PLATE• Personalized U.S. Military Veteran registration plates may contain:

For Persian Gulf War Veteran registration plates up to FIVE letters and/or numbers incombination. If a hyphen or space is used as part of the registration configuration, it counts asone of the available spaces for personalization. Only one hyphen or space is permitted, but notboth. No additional special characters are available. Please use capital letters and print clearly.When requesting a numeric character of zero, please show as "Ø" instead of the alphacharacter "O." Since this is an electronically fillable form, after printing the form, please besure any zero is marked with a "/." NOTE: A pre-printed letter configuration of “PG” willprecede your personalized configuration on your registration plate and cannot be changed.

For U.S. Air Force Veteran registration plates up to FIVE letters and/or numbers incombination. If a hyphen or space is used as part of the registration configuration, it counts asone of the available spaces for personalization. Only one hyphen or space is permitted, but notboth. No additional special characters are available. Please use capital letters and print clearly.When requesting a numeric character of zero, please show as "Ø" instead of the alphacharacter "O." Since this is an electronically fillable form, after printing the form, please be sureany zero is marked with a "/." NOTE: A pre-printed letter configuration of “AF” will follow yourpersonalized configuration on your registration plate and cannot be changed.

SAMPLE

SAMPLE

For U.S. Army Veteran registration plates up to FIVE letters and/or numbers in combination.If a hyphen or space is used as part of the registration configuration, it counts as one of theavailable spaces for personalization. Only one hyphen or space is permitted, but not both.No additional special characters are available. Please use capital letters and print clearly. Whenrequesting a numeric character of zero, please show as "Ø" instead of the alpha character "O."Since this is an electronically fillable form, after printing the form, please be sure any zero ismarked with a "/." NOTE: A pre-printed letter configuration of “AR” will follow your personalizedconfiguration on your registration plate and cannot be changed.

For U.S. Coast Guard Veteran registration plates up to FIVE letters and/or numbers incombination. If a hyphen or space is used as part of the registration configuration, it counts asone of the available spaces for personalization. Only one hyphen or space is permitted, but notboth. No additional special characters are available. Please use capital letters and print clearly.When requesting a numeric character of zero, please show as "Ø" instead of the alphacharacter "O." Since this is an electronically fillable form, after printing the form, please be sureany zero is marked with a "/." NOTE: A pre-printed letter configuration of “CG” will follow yourpersonalized configuration on your registration plate and cannot be changed.

For U.S. Marine Corps Veteran registration plates up to FIVE letters and/or numbers incombination. If a hyphen or space is used as part of the registration configuration, it counts asone of the available spaces for personalization. Only one hyphen or space is permitted, but notboth. No additional special characters are available. Please use capital letters and print clearly.When requesting a numeric character of zero, please show as "Ø" instead of the alphacharacter "O." Since this is an electronically fillable form, after printing the form, please be sureany zero is marked with a "/." NOTE: A pre-printed letter configuration of “MC” will follow yourpersonalized configuration on your registration plate and cannot be changed.

For U.S. Navy Veteran registration plates up to FIVE letters and/or numbers in combination.If a hyphen or space is used as part of the registration configuration, it counts as one of theavailable spaces for personalization. Only one hyphen or space is permitted, but not both.No additional special characters are available. Please use capital letters and print clearly. Whenrequesting a numeric character of zero, please show as "Ø" instead of the alpha character "O."Since this is an electronically fillable form, after printing the form, please be sure any zero ismarked with a "/." NOTE: A pre-printed letter configuration of “NA” will follow your personalizedconfiguration on your registration plate and cannot be changed.

For Vietnam War Veteran registration plates up to FIVE letters and/or numbers in combination.If a hyphen or space is used as part of the registration configuration, it counts as one of theavailable spaces for personalization. Only one hyphen or space is permitted, but not both.No additional special characters are available. Please use capital letters and print clearly. Whenrequesting a numeric character of zero, please show as "Ø" instead of the alpha character "O."Since this is an electronically fillable form, after printing the form, please be sure any zero ismarked with a "/." NOTE: A pre-printed letter configuration of “VW” will precede yourpersonalized configuration on your registration plate and cannot be changed.

For Veteran registration plates up to FIVE letters and/or numbers in combination. If a hyphen orspace is used as part of the registration configuration, it counts as one of the available spacesfor personalization. Only one hyphen or space is permitted, but not both. No additional specialcharacters are available. Please use capital letters and print clearly. When requesting a numericcharacter of zero, please show as "Ø" instead of the alpha character "O." Since this is anelectronically fillable form, after printing the form, please be sure any zero is marked with a "/."NOTE: A pre-printed letter configuration of “US” will follow your personalized configuration onyour registration plate and cannot be changed.

For Veteran Motorcycle registration plates up to FOUR letters and/or numbers in combination.If a hyphen or space is used as part of the registration configuration, it counts as one of theavailable spaces for personalization. Only one hyphen or space is permitted, but not both. No additional special characters are available. Please use capital letters and print clearly. Whenrequesting a numeric character of zero, please show as "Ø" instead of the alpha character "O."Since this is an electronically fillable form, after printing the form, please be sure any zero ismarked with a "/." NOTE: A pre-printed letter configuration of “V” will precede your personalizedconfiguration on your registration plate and cannot be changed.

For U.S. Merchant Marine Veteran registration plates up to FIVE letters and/or numbers incombination. If a hyphen or space is used as part of the registration configuration, it counts asone of the available spaces for personalization. Only one hyphen or space is permitted, but notboth. No additional special characters are available. Please use capital letters and print clearly.When requesting a numeric character of zero, please show as "Ø" instead of the alphacharacter "O." Since this is an electronically fillable form, after printing the form, please be sureany zero is marked with a "/." NOTE: A pre-printed letter configuration of “MM” will follow yourpersonalized configuration on your registration plate and cannot be changed.

SAMPLE

SAMPLE

SAMPLE

SAMPLE

SAMPLE

SAMPLE

SAMPLE

SAMPLE

Visit us at www.dmv.pa.gov or call us at:In state: 1-800-932-4600 u TDD: 1-800-228-0676 u Out-of-State: 1-717-412-5300 u TDD Out-of-State: 1-717-412-5380

• PennDOT reserves the right to limit or reject requests.

• The Korean War Veteran and the World War II Veteran registration plates cannot be personalized at this time.

• The fee to personalize your registration plate is an additional $104, and the registration on your vehicle must be current in order for PennDOT to process your request. The additional $104 fee covers the cost of your personalized registration plate order only and will not renew your vehicle's registration. If your registration has expired or expires in the next three months, please include your completed renewal application, Form MV-105, "Pennsylvania Registration Renewal Application," or Form MV-140, “Request for Registration,” and a separate check or money order in the amount of your registration renewal fee. Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. PLEASE DO NOT SEND CASH

• To check personalized registration plate availability, visit PennDOT’s Driver and Vehicle Services website, www.dmv.pa.gov, and select Plate Availability from the list of services under the Online Services heading. Personalized registration plates will not be reserved until PennDOT receives payment and a completed application, and approves your requested registration plate configuration [number(s) and/or letter(s)]. Please note that registration plate requests are processed on a first-come, first-served basis. Although a requested registration plate configuration may show as being available on the website, it is possible that a request for the same registration plate configuration may have already been submitted by another customer and may not be available when making application.

• Personalized registration plates will be manufactured on the basis of this application. NO REFUND of the fee will be issued when an applicant cancels a request after the order is placed with the manufacturer.

• Allow eight to 10 weeks for delivery.