Form Hsmv 83030 - Application For U.s. Reserve Or Florida National Guard License Plate

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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR U.S. RESERVE OR FLORIDA NATIONAL GUARD LICENSE PLATE
SUBMIT APPLICATION TO YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE OR LICENSE PLATE AGENCY
See Reverse Side of this form for Provisions of Law and Instructions
1. I, ____________________________________________ hereby certify that I am a legal resident of Florida, residing at
______________________________________________________________________________________________________
(Address)
(City)
(State)
(Zip)
and I am the registered owner of the following described motor vehicle:
YEAR _________
MAKE _________________________
CURRENT LICENSE PLATE NUMBER ________________________
TITLE NUMBER _____________________ VEHICLE IDENTIFICATION NUMBER _____________________________________________
OWNER/LESSEE'S: DATE OF BIRTH _________________ SEX ____ OWNER/LESSEE'S DL NUMBER ___________________________
OWNER/LESSEE’S EMAIL ADDRESS: ________________________________________________________________________________
2. This is to certify that I, ___________________________________________________, am an active/retired member of the
U.S. Reserve or Florida National Guard who is applying for the following as indicated:
U.S. Reserve License Plate
Florida National Guard License Plate (Choose from the following):
NOTE: An active Florida National Guard may be issued ONE FREE license plate/registration each year. However,
any Initial Registration, specialty and/or personalized fees would still apply, when applicable.
A.
One Free Original Florida National Guard License Plate/Registration for Active Florida National Guard Member.
B.
One Free Original Regular/Specialty/Personalized License Plate/Registration for Active Florida National Guard Member in lieu of a
National Guard plate.
C.
Free Annual Renewal of my current Florida National Guard/Regular/Specialty/Personalized License Plate (active Florida National Guard member).
D.
Retired OR Active Member of the Florida National Guard applying for an Original National Guard License Plate (not exempt from fees).
E.
Active Member of the Florida National Guard renewing their National Guard License Plate (not exempt from fees).
_____________________________________________________________
Signature of the member for the above indicated license plate
A RETIRED MEMBER MUST SIGN ABOVE AND PROVIDE PROOF OF THEIR RETIREMENT (This proof is only needed when an original is being applied for).
AN ACTIVE MEMBER MUST SIGN ABOVE AND ALSO HAVE THE FOLLOWING STATEMENT SIGNED BY THEIR FIRST SERGEANT OR COMMANDING OFFICER:
This is to certify that ________________________________________________ is an active member of the U.S. Reserve or Florida National
Guard
___________________________________________________________________
____________________________________________
Signature of the First Sergeant OR Signature & Rank of Commanding Officer
Telephone Number of Sergeant/Commanding Officer
HSMV 83030 - 09/19/12

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