Form Mvd-10100 - Application For Gold Star Family Plate

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New Mexico Taxation & Revenue Department, Motor Vehicle Division
INT. 09/09
Gold Star Family registration plates are available to the surviving mother, father, stepparent or spouse of a service
member killed in an armed conflict with an enemy of the United States. The division shall issue special registration
plates for no more than four vehicles per Gold Star Family.
A separate application form must be completed and submitted for each Gold Star Family special registration plate that
is applied for. Applications will be processed in the order that they are received by the MVD Vehicle Services Unit.
Applicant information MUST be as shown on the vehicle’s current registration form.
There is no charge for this special plate. No fee, including the regular registration fee, shall be collected for issuance of
the first Gold Star Family registration plate (one plate only) that is issued to the service member’s mother or spouse.
Return completed form to: Motor Vehicle Division, Vehicle Services Bureau P.O. Box 1028, Santa Fe, NM 87504-1028
Applicant Information
Phone Number
Mailing Address
City, State, ZIP code
Relationship (spouse, parent or stepparent) to service member
Vehicle Information
Current License Plate Number
Vehicle Identification Number (VIN)
Make of Vehicle
Model of Vehicle
Body Type
In all cases submit a copy of the Report of Casualty (DD Form 1300) and, if
Military Service
Applicant is surviving spouse, a copy of the marriage certificate.
Service Member’s Name (as it appears on Report of Casualty DD Form 1300 or other military service documentation)
Branch of Service
Date Entered Service
Date of Birth
Social Security Number
Date of Death
Applicant’s Certification
Department of Veterans’ Services Certification
I hereby certify that the information given above and any
I hereby certify that Applicant’s request for special plate
accompanying documentation is true and correct to the
and decal is supported by accompanying documentation
best of my knowledge.
and/or the service record.
Applicant’s Signature
Approved by


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