Form 803v - Application For Personalized Veteran Plates
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1
2STATE OF ALASKA - DIVISION OF MOTOR VEHICLES
APPLICATION FOR PERSONALIZED VETERAN PLATES
Name
Telephone Number (Daytime)
Current License Plate Number
Expiration Date
Serial Number (VIN)
YES
NO
Year
Make
Body Style
Is Vehicle Used Commercially?
PLATE TYPE:
VEHICLE
MOTORCYCLE/TRAILER
TRAILER
(SMALL)
(LARGE PLATE)
PLATE DESIGN:
AIR FORCE
ARMY
COAST GUARD
COMMEMORATIVE VETERAN
MARINE
NAVY
NATIONAL GUARD
SUPPORT OUR TROOPS
GOLD STAR FAMILY
LAO VETERAN
UNIT EMBLEM _____________________(See choices)
:
LOST / DAMAGED / REPLACEMENT
STOLEN
Replacement Plates (reason)
PLEASE READ THE INSTRUCTIONS ON THE NEXT PAGE BEFORE COMPLETING THIS FORM.
USE ONLY THE LETTERS AND NUMBERS SHOWN IN THE INSTRUCTIONS ON THE NEXT PAGE.
Print the letters and/or numbers you want on your new license plate(s) in the
ST
1
Choice
blocks provided. If a space is required between characters, indicate this by
leaving the block blank. Select your choice of plate style AND design above.
THE PLATE(S) WILL BE MAILED TO THE ADDRESS SHOWN IN DMV RECORDS
ND
2
Choice
UNLESS YOU REQUEST OTHERWISE, IN WRITING. To change your address,
write the change on the copy of the Alaska vehicle registration submitted.
Provide a completed and signed Notice of Change of Address (Form 401) for
RD
3
Choice
other vehicles/drivers licenses that require a change of address.
Enclose all of the following that apply to you:
Current registration and payment.
TH
4
Choice
Address correction.
Copy of DD-214 or military identification.
TH
5
Choice
Copy of DD Form 1300 and other proof, if required.
Lao Veteran Plate: Documentation showing proof of
service or affidavit below.
LAO Veteran Certification:
I certify that ___________________________________ served in military operations in support of the
(Print Full Name)
th
United States Government in Kingdom of Laos during the Vietnam Conflict between February 28th, 1961 and May 15
, 1975.
Relationship
Officer
Certifying Authority Signature: ______________________________
Date: ____/___/20___
Other Serving Member
Family or Other Member
Certifying Authority Printed Name: ___________________________
Other:_______________________________________________________________________
If you would prefer a unit emblem instead of a branch service emblem, a list is available your local DMV office or on
the web at
. For further information, send your inquiry
to: DOA.DMV.Webmaster@Alaska.gov
STATE OF ALASKA
DIVISION OF MOTOR VEHICLES
1300 W BENSON BLVD, STE 200
ANCHORAGE, AK 99503-3600
/
/20
Signature
Date
DMV USE ONLY:
NEW CLASS CODE
DATE
BATCH
AMVC / OFFICE
FEE:
CA
CC
CK
Form 803V (Rev. 12/2012)
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