Form Mv58 - State Of Montana Application For Next Of Kin Of Deceased Personnel License Plate Page 2

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READ BEFORE COMPLETING THIS APPLICATION
PRIVACY ACT STATEMENT
AUTHORITY: MCA 61-3-458; Code of Federal Regulations Title 32, Section 578.63
PRINCIPAL PURPOSE: To evaluate the applicant's eligibility to receive the Next of Kin of Deceased
Personnel License Plate.
ROUTINE USE: To identify the applicant and establish a distribution record.
DISCLOSURE: Voluntary; however, if not provided, an eligible individual will not be issued the Next of Kin of
Deceased Personnel License Plate.
INFORMATION
Montana Code Annotated 61-3-458 authorizes the design and distribution of the Next of Kin of Deceased
Personnel License Plate within the state of Montana to qualified family members of members of the Armed
Forces of the United States who lost their lives while serving on active duty or while assigned in an
Army Reserve or Army National Guard unit in a drill status. Please note that the law does not currently
extend this license plate option to other Reserve or Guard categories.
NOTE: Per Code of Federal Regulations criteria, deceased status must be as of March 29, 1973 (to present).
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Montana county and state authorities reserve the right to reject any form that has been altered.
MV58 (10/13)
This form is available in alternate formats for people with disabilities.

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