STATE OF DELAWARE DIVISION OF MOTOR VEHICLES APPLICATION FOR

STATE OF CALIFORNIA C THE RESOURCES AGENCY PRIMARY
 EMPLOYEES’ COMPENSATION DIVISION LABOUR DEPARTMENT STATEMENT OF
 LOGO [NAME OF ORGAN OF STATE] G4(FR) ACCEPTANCE

BILL LOCKYER STATE OF CALIFORNIA ATTORNEY GENERAL DEPARTMENT OF
CHARACTERISATION OF FUEL CELL STATE USING ELECTROCHEMICAL IMPEDANCE SPECTROSCOPY
      STATEMENT ON RESTITUTION

STATE OF DELAWARE

STATE OF DELAWARE

DIVISION OF MOTOR VEHICLES


APPLICATION FOR PURPLE HEART RECIPIENT LICENSE PLATE

www.dmv.de.gov

(Type or Print)



DATE OF APPLICATION


REGISTRATION NO. MGR. & YEAR


VEHICLE IDENTIFICATION NO.


NAME TELEPHONE NO.


ADDRESS



SIGNATURE OF APPLICANT


A copy of the official documentation indicating eligibility for a purple heart license plate must be witnessed or presented at the time of application.


Letter attached Witnessed Documents


Applicant must be a veteran of World War I, World War II, the Korean Conflict, the Vietnam Conflict, Desert Storm or other military conflicts on foreign soil in which United States Armed Forces were formally engaged in battle.


I understand the special plate is to be displayed only on the vehicle described above. (If you trade vehicles, your registration card showing the plate must be presented to the Division of Motor Vehicles so a new card can be issued.


The fee of $10.00 must accompany this application. Application and documentation may be presented at any DMV office. This is a one-time charge only. However, you must still continue to have your vehicle inspected any pay your registration fee (as required).


Only one (1) plate shall be issued to an applicant. Upon receipt of notice that the individual to whom the plate is issued is deceased, the plate must be returned to the Division of Motor Vehicles within 90 days per Title 21, Section 2139B.


Plates may be issued only on cars, station wagons or trucks with not more than three-fourth ton maximum gross weight.



Authorized Signature

purpleheart (3/01)


      VICTIM IMPACT STATEMENT
  FOR DEATH PRIOR TO 01061959 ADMINISTRATION (INTESTATE)
CONFIGURING USER STATE MANAGEMENT FEATURES 73 CHAPTER 7 IMPLEMENTING


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