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Georgia Department of Revenue Form MV-9W (Rev. 6-2015) Web and MV Manual Georgia Department of Revenue - Motor Vehicle Division Request for Manufacture of a Special Veteran License Plate ______________________________________________________________________________________ Purpose of this Form: This form is to be used to apply for a military license plate/tag. This form should not be used to record a change of ownership, change of address, or change of license plate classification. Required documentation: You must provide a legible copy of your service discharge (DD-214, DD-215, or for World War II veterans, a WD form) indicating your branch and term of service. If you are an active duty member, a copy of the approved documentation supporting your current membership in the respective reserve or National Guard unit is required. In the case of a retired reserve member from that unit, you must furnish approved documentation supporting the current retired membership status from that reserve unit. OWNER INFORMATION First Name Middle Initial Last Name Suffix Owners’ Full Legal Name: Mailing Address: City: State: Zip: Telephone Number: Owner(s)’ Full Legal Name: First Name Middle Initial Last Name Suffix If secondary Owner(s) are listed Mailing Address: City: State: Zip: Telephone Number: VEHICLE INFORMATION Passenger Vehicle Motorcycle Private Truck Vehicle Identification Number (VIN): Year: Make: Model: CAMPAIGN/TOUR of DUTY Branch of Service: SERVICE AWARD Branch of Service: LICENSE PLATES ______________________ LICENSE PLATES ______________________ World War I World War II Medal of Honor Bronze Star Medal (7/28/1914 – 11/11/1918) (12/07/41 – 12/31/46) Silver Star Medal Army Distinguished Service Cross Korean War Vietnam War Navy Cross (6/27/50 – 1/31/55) (6/1/54 – 5/15/75) Air Medal Distinguished Service Medal War in Afghanistan Operation Desert Storm Legion of Merit Defense Distinguished (10/07/01 – Current) (8/02/90 – 11/30/95) Service Medal Air Force Cross War in Iraq Global War on Terrorism Distinguished Flying Cross Purple Heart (12/07/01 – Current) (3/20/03 – 12/18/11) Homeland Security Defense Superior Service Chosin Reservior Campaign Military Veteran Distinguished Service Medal of 1950 Former Prisoner of War Retired from Active Duty Retirement Date: __________________ Gold Star Family U.S. Reserves, National Guard, Branch of Service: DISABLED VETERAN Branch of Service: Georgia National Guard ______________________ LICENSE PLATE ______________________ Retired U.S. Reserve Date: ____________________ 100% Service Connected Disabled Veteran or less than 100% Retired Georgia National Guard Date: ____________________ Service Connected Disabled but is compensated at 100% level due to individual unemployabilty.* Active Duty Georgia National Guard * Compensated at less than 100% level or Nonservice Connected Active Duty U.S. Reserve * Disabled* * You must provide a letter from U.S. Department of Veteran Affairs indicating * Active Duty members shall provide annual letter from Commanding Officer to disability percentage and service connection. The Georgia Department of county tag office. Veterans Services (GDVS) is available for assistance. CERTIFICATION Veteran /Active Military Personnel Surviving Spouse Minor Child O.C.G.A. § 40-2-3. “Any person who shall make any false statement in any application for the registration of any vehicle, or in transferring any certificate of registration, or in applying for a new certificate of registration, shall be guilty of false swearing, whether or not an oath is actually administered to him, if such statement shall purport to be under oath. On conviction of such offense, such person shall be punished as provided by Code Section 16-10-71.” State of Georgia Driver’s License Number: _________________________ ______________ Signature Date Have a question? Visit our website at http://dor.georgia.gov/motor-vehicles or scan the QR code above for more information. INSTRUCTIONS How to complete the MV-9W Form APPLICANT INFORMATION – This form can only be submitted by a Veteran, Active Military or a surviving spouse. Veteran/Active Military Personnel: a person who served in the active military, and who was discharged or released under honorable conditions. Surviving Spouse: means (except for purposes of chapter 19 of this title) a person who was the spouse of a veteran at the time of the veteran's death, and who lived with the veteran continuously from the date of marriage to the date of the veteran's death. COMPLETING the APPLICATION Complete the registrant/owner information. The mailing address block should contain the physical address of the registrant. Complete the vehicle information for which the request for a special veteran/military license plate is being requested. Check the category of license plate that belongs on the vehicle to which you intend to register this plate. Check the type of license plate you would like issued. Please note that some license plates require additional documentation and/or requirements which are noted below. Military license plates are issued only to those vehicles titled in Georgia. EXAMPLES of ACCEPTABLE DOCUMENTATION 1. Enlisted Record and Report of Separation (Form WD AGO 53-55) - must 5. Certificate of Release or Discharge from Active Duty (Form DD214) - must state Honorable or General Discharge, the dates of active duty service; your state Honorable or General Discharge, the dates of active duty service; your commendations, award or medal. commendations, award or medal; 2. General Orders; 6. Report of Separation and Record of Service (Form NGB 22); or 3. Correction to Form DD214 (Form DD215); 7. Current Military ID Card 4. Official Discharge Order from the United States Armed Forces; FEES All Special Veterans License plates are free for one vehicle. Additional tags: $25 manufacturing fee (one time fee) plus $20 annual registration fee. Ad Valorem tax exemption (either annual property or title tax): This applies to one vehicle registered to 100% Service Connected Veteran, Purple Heart, Medal of Honor, Prisoner of War or Surviving Spouse of POW. All other tags are subject to applicable taxation. *** CRITERIA for CAMPAIGN/TOUR of DUTY and MILITARY MEDAL AWARD LICENSE PLATES *** CAMPAIGN/TOUR of DUTY LICENSE PLATES: To be eligible for this plate you must have had active duty service in World War I, World War II, the Korean War, the Vietnam War, Operation Desert Storm, the Global War on Terrorism as defined by Presidential Executive Order 13289, Section 2, the War in Afghanistan, or the War in Iraq, which includes either Operation Iraqi Freedom or Operation Enduring Freedom. The applicant must submit ONE of the seven (7) documents listed, which must be properly completed, signed, show honorable discharge, and list the citations or decorations he or she received for serving in the designated war or conflict. GENERAL/RETIRED LICENSE PLATES (Including Retired National Guard): The applicant must submit a copy of his or her current military ID card, proof of retired status, or ONE of the seven (7) documents to show honorable discharge. MILITARY MEDAL AWARD LICENSE PLATES: To be eligible for this plate the individual was issued a medal, decoration, or other recognition of honor for military service awarded by a branch of the United States military. GOLD STAR FAMILY PLATES: The applicant who has had an immediate family member die in the line of duty while serving in the United States Armed Forces. Submit veteran’s Death Certificate accompanied by Marriage Certificate (if applicable) and DEER listing a spouse, mother, father, sibling, surviving spouse of sibling, child or step-parent. PURPLE HEART RECIPIENT: Active Duty Service members shall provide their original citation which will be photocopied by the county tag office. FORMER PRISONER of WAR PLATES: The applicant must submit a copy of former POW membership card, or a statement from the United States Department of Veterans Affairs or the United States Department of Defense, or ONE of the seven (7) documents listed. *** MEMBERS of ACTIVE RESERVE COMPONENTS or MEMBERS of the GEORGIA NATIONAL GUARD *** Members of active reserve components of the United States O.C.G.A. §40-2-65 For Active Duty Members: The commanding officer of each active reserve component program unit or the adjutant general of the National Guard unit of each neighboring state shall, upon request of any reserve member or National Guard member of that unit, respectively, furnish to that member approved documentation supporting the member's current membership in the respective reserve or National Guard unit. For Retired Members: The commanding officer of each active reserve component program unit shall, upon request of any retired reserve member from that unit, furnish to that retired member approved documentation supporting the retired member's current retired membership status from that reserve unit. Members of Georgia National Guard O.C.G.A. §40-2-66 For Active Duty Members: The adjutant general of Georgia shall, upon request of any member of that National Guard unit, furnish to that member approved documentation supporting the member's current membership in that National Guard unit. For Retired Members: The adjutant general of Georgia shall, upon request of any member retired from that National Guard unit, furnish to that retired member approved documentation supporting the member's retired membership status in that National Guard unit. Note: Surviving Spouse - The spouse of a member of the military, National Guard or U.S. Reserves who is killed while serving in a combat arena shall continue to be eligible to be issued a distinctive license plate as provided in this Code section so long as such spouse does not remarry. Spouse must provide certified copy of Death Certificate accompanied by certified copy of Marriage Certificate. Have a question? Visit our website at http://dor.georgia.gov/motor-vehicles or scan the QR code for more information. .
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