Form MV-145V, Application for Severely Disabled Veteran, Severely Disabled Veteran Motorcycle Plate Decal or Disabled Veteran Registration Plate Instructions

Please enter the full name of the applicant. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the applicant's Pennsylvania Driver License or Photo ID number. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the applicant's date of birth. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Enter the printed name and title of the individual providing authorization.

Please enter the full name of the co-applicant. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the Pennsylvania Driver's License or Photo ID number for the co-applicant. Fill only if 'Co-Applicant Name' has a value.

Please provide the date of birth for the co-applicant. Fill only if 'Co-Applicant Name' has a value.

Please provide the printed full name of the co-applicant. Fill only if 'Co-Applicant Name' is filled

Please enter the telephone number of the co-applicant. Fill only if 'Co-Applicant Printed Name' is filled.

Please enter the veteran's Department of Veterans Affairs (VA) identification number. Fill only if 'Disabled Veteran Plate (12)' is 'Yes'.

Please enter the service-connected disability rating percentage. Fill only if 'Disabled Veteran Plate (12)' is 'Yes'.

Please provide the printed full name of the disabled veteran.

Please enter the telephone number of the disabled veteran.

Please enter the street address. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the city name. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the state. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the zip code. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Check this box if you are applying for a Severely Disabled Veteran Plate (E4).

Check this box if you are applying for a Severely Disabled Veteran Motorcycle Plate Decal.

Check this box if you are applying for a Disabled Veteran Plate (12).

Check this box if you are applying for two Severely Disabled Veteran Plates (IX) for a vehicle equipped with a Wheelchair/Personal Assistive Device Carrier.

Check this box if you are applying for two Disabled Veteran Plates (IW) for a vehicle equipped with a Wheelchair/Personal Assistive Device Carrier.

Check this box if you have a 100% service-connected disability as certified by the U.S. Department of Veterans Affairs or a service unit, and have completed Section C or attached the required documentation. Fill only if 'Severely Disabled Veteran Plate (E4)' is 'Yes'.

Check this box if your eligibility is based on the loss of a limb, an eye, or becoming partially paralyzed while serving in the Armed Forces of the United States. Fill only if 'Severely Disabled Veteran Plate (E4)' is 'Yes'.

Check this box if your eligibility is not based on a 100% service-connected disability, or the loss of a limb, an eye, or partial paralysis. Fill only if 'Severely Disabled Veteran Plate (E4)' is 'Yes'.

Check this box if you certify that you have not previously received a free Severely Disabled Veteran registration. Fill only if '100% Service-Connected Disability', 'Loss of Limb, Eye, or Partial Paralysis' is 'Yes' on any.

Check this box if you certify that you have not previously received a free Disabled Veteran registration. Fill only if '100% Service-Connected Disability', 'Loss of Limb, Eye, or Partial Paralysis' is 'Yes' on any.

Enter your desired first choice for personalized registration plate, which may contain up to five letters or numbers.

Enter your desired second choice for personalized registration plate, which may contain up to five letters or numbers. Fill only if 'First Choice Personalization' is filled.

Enter your desired third choice for personalized registration plate, which may contain up to five letters or numbers. Fill only if 'Second Choice Personalization' is filled.

Enter the veteran's Department of Veterans Affairs (VA) number. Fill only if 'Severely Disabled Veteran Plate (E4)' is 'Yes'.

Enter the veteran's service-connected disability rating as a percentage. Fill only if 'Severely Disabled Veteran Plate (E4)' is 'Yes'.

Provide the service-connected eligibility reason code if the disability rating is less than 100%. Fill only if 'Service-Connected Disability Rating Percentage' is less than 100%.

Specify the type of device used if reason code #4 is applicable for eligibility. Fill only if 'Eligibility Reason Code' is '#4'.

Please enter the day of the month the document was signed.

Please enter the month the document was signed.

Please enter the year the document was signed.

Please provide the county or other location and state where the document was signed.

Please provide the country where the document was signed.

Please enter the vehicle's title number as it appears on the current registration card. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the vehicle's identification number (VIN) as it appears on the current registration card. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the current registration plate number of the vehicle as it appears on the current registration card. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.

Please enter the current expiration date of the vehicle's registration as it appears on the current registration card. Fill only if 'APPROPRIATE BLOCKS' is 'Yes'.