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Application for License Number Form VTR-999 Specialty License Plates Mo/Yr of Exp (Rev. 11/11) Page 1 of 2 Date Issued

INSTRUCTIONS

Submit the completed application, payment in the form of a personal check, money order or cashier’s check, and any required attachments to your local County Tax Assessor-Collector's office. Do not mail cash. Based on the plate you select, the specialty plate fee is $30 or $40 per year in addition to the annual registration fee. Plate may be personalized for an additional fee, make selection on page 2.

NOTE: When the specialty plate is issued, additional fees may be collected to establish a single expiration date for both the specialty plate and the vehicle registration. If you place your order online or by mail, please contact your County Tax Assessor-Collector’s office in 2-3 weeks to verify your plate is ready for issuance. Specialty plate fees will not be refunded once application is submitted. Contact your County Tax Assessor-Collector if you have any questions.

APPLICANT INFORMATION - Type or print only Last Name First Name Middle Initial County

Address City State ZIP

Phone Alternate Phone E-mail

Vehicle Type Passenger car Truck (up to 18,000 lbs.) Motorcycle/moped

SPECIALTY PLATE CHOICES - Note: All plates are available for passenger cars and trucks up to 18,000 lbs. Plates available for motorcycles/mopeds are indicated by ( M ). Specialty plates available for a $30 fee (Fee is in addition to annual registration fee) 4-H I Love Texas State Capitol Adopt a Beach (M) (Deaf and Hard of Hearing) State of the Arts Animal Friendly Insure Texas Kids (M) (Texas Commission on the Arts) Air Force Association Keep Texas Beautiful Stop Child Abuse (M) American Quarter Horse (Don't Mess With Texas) Texans Conquer Cancer Be A Blood Donor Knights of Columbus Texas Aerospace Commission Big Bend National Park (M) March of Dimes Texas Lions Camp Big Brothers Big Sisters Marine Mammal Recovery Texas Masons (M) Boy Scouts of America Mothers Against Drunk Driving (M) Texas Master Gardner CASA - Court Appointed Special Native Texan Texas Music Advocate (Daughters of the Republic of Texas) (M) Texas Reads Choose Life (M) Organ Donor Texas State Rifle Association Coastal Conservation - Redfish (M) Read To Succeed Texas Trails (M) College for All Texans (M) Red Grapefruit (Texas Citrus Industry) Texas Young Lawyers (And Justice For All) Cotton Boll Rotary International (M) Texas. It’s Like A Whole Other Country Ducks Unlimited (Blue Heron) (M) San Jacinto Texas Historic District (M) (Texas Department of Economic Development) Ducks Unlimited (Classic) (M) Share The Road Y'all (Bicycle) United States Olympic Committee El Paso Mission Valley Smile Texas Style (Olympic Spirit) Fight Terrorism (M) Space Shuttle Columbia United We Stand Girl Scouts Special Olympics Urban Forestry YMCA Texas Parks and Wildlife – Conservation Professional Sports Teams Bluebonnet (“Parks and Wildlife”) (M) Horned Lizard (“Keep Texas Wild”) (M) Largemouth Bass (“Fish Texas”) (M) White-tailed Deer (“Hunt Texas”) (M)

Specialty plates available for a $40 fee (Fee is in addition to annual registration fee) God Bless America (M) God Bless Texas (M)

FORM VTR-999 Online Form at www.TxDMV.gov Form VTR-999 (Rev. 11/11) Page 2 of 2 GENERAL REQUIREMENTS

w Texas title and vehicle registration must be in your name. w If you recently filed an application for title, attach a copy of the title application (VTR-500 RTS) receipt. w If more than one vehicle, submit a separate application for each vehicle. w If the vehicle is leased, attach a photocopy of the lease agreement. w Vehicle is for personal use only.

OTHER SPECIALTY PLATES To request a: Use the following VTR Form: Collegiate VTR-228 Out of State Collegiate (Alumni Organization) VTR-229 Go Texan (Texas Agricultural Products) VTR-810 Houston Livestock Show and Rodeo VTR-367 Texas Association of Realtors VTR-415 Omega Psi Phi Fraternity VTR-415 American Legion VTR-415

PERSONALIZE YOUR PLATE - If you would like to personalize your specialty plate, there will be a $40 fee per year, in addition to the annual registration fee and the Specialty Plate Fee.

INSTRUCTIONS:

w Show selections exactly as you wish them to appear on your license plate. You may list more than one option in the event the personalization you have chosen is already issued. w A selection that has already been issued, is deemed offensive, or conflicts with the regular license plate numbering system cannot be approved. w Use each selection block below to represent one character - defined as one letter, number, period, dash, blank space, Texas silhouette, or the heart symbol. Use an asterisk ( * ) to indicate the Texas silhouette, and an at sign (@) to indicate the heart symbol. w Passenger car and truck plates are limited to five (5) characters total. w Motorcycle and moped plates are limited to four (4) characters total. w You are not required to use all the spaces provided.

w The International Symbol of Access (ISA) counts as two (2) characters. If you are disabled and applying for personalized specialty plates, the plate may consist of only three characters (or two, if for a motorcycle/moped). Use a percent sign (%) to indicate the International Symbol of Access.

Please be sure you like all of your personalized plate selections as refunds will not be issued.

1st Selection 2nd Selection 3rd Selection

INTERNATIONAL SYMBOL OF ACCESS

To display a disabled person symbol on your license plate, please attach a signed Form VTR-214 to this application to show your eligibility. The ISA is available for vehicles 18,000 lbs. or less. Contact your County Tax Assessor-Collector’s office for more information.

FORM VTR-999 Online Form at www.TxDMV.gov