"Application for Gold Star Family License Plates" - Nebraska

Application for Gold Star Family License Plates is a legal document that was released by the Nebraska Department of Motor Vehicles - a government authority operating within Nebraska.

Form Details:

  • Released on October 1, 2019;
  • The latest edition currently provided by the Nebraska Department of Motor Vehicles;
  • Ready to use and print;
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  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Motor Vehicles.

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Application for
Gold Star Family License Plates
§60-3,122.01
See Reverse Side for Additional Information
Applicant Information
Vehicle Information
Name
VIN
Address
Make
Year
City
State NE Zip
County of Registration
Co #
Email Address
Title Number
Daytime Phone (
)
Current Plate #
Is vehicle leased?
Yes
No
IMPORTANT:
Applicant’s name must appear on the
Lessor
Nebraska Certificate of Title or, in the event the vehicle is
leased or non-resident military, the registration of the vehicle.
Motor vehicles, motorcycles/autocycles, trailers, semitrailers and
Non-resident military must include a copy of their registration
cabin trailers are eligible for a Gold Star Family License Plate.
with this application.
If a resident of Douglas or Lancaster County, office location where plates will be picked up:
________________________
(SEE REVERSE FOR PICK-UP LOCATION OPTIONS)
Check here if you are making application for a Gold Star Numeric License Plate (you will be issued the next available
number).
$40.00 - Check here if you are applying for a Gold Star Message License Plate and indicate your message choices
below in order of preference (the first available message choice will be processed):
2nd Choice
1st Choice
3rd Choice
Meaning (required):
Meaning (required):
Meaning (required):
As the above-named applicant I am making application for a Gold Star Family license plate. As part of this application
process, I am affirming that I meet the following criteria:
I am the surviving spouse, an ancestor, a descendant or a sibling of a person who died while in good
standing on active duty in the military service of the United States.
Date
Signature of Motor Vehicle Owner
Filing of a false application violates the provisions of the Motor Vehicle Registration Act. Any person that does so may be subject to prosecution and
cancellation of your certificate of registration.
Submit the completed application for approval to:
1HERO
Nebraska Department of Motor Vehicles
Driver and Vehicle Records Division
P.O. Box 94789
Gold Star Message
Lincoln, NE 68509-4789
Gold Star Numeric
PLEASE READ CAREFULLY
Revised 12/2020
Application for
Gold Star Family License Plates
§60-3,122.01
See Reverse Side for Additional Information
Applicant Information
Vehicle Information
Name
VIN
Address
Make
Year
City
State NE Zip
County of Registration
Co #
Email Address
Title Number
Daytime Phone (
)
Current Plate #
Is vehicle leased?
Yes
No
IMPORTANT:
Applicant’s name must appear on the
Lessor
Nebraska Certificate of Title or, in the event the vehicle is
leased or non-resident military, the registration of the vehicle.
Motor vehicles, motorcycles/autocycles, trailers, semitrailers and
Non-resident military must include a copy of their registration
cabin trailers are eligible for a Gold Star Family License Plate.
with this application.
If a resident of Douglas or Lancaster County, office location where plates will be picked up:
________________________
(SEE REVERSE FOR PICK-UP LOCATION OPTIONS)
Check here if you are making application for a Gold Star Numeric License Plate (you will be issued the next available
number).
$40.00 - Check here if you are applying for a Gold Star Message License Plate and indicate your message choices
below in order of preference (the first available message choice will be processed):
2nd Choice
1st Choice
3rd Choice
Meaning (required):
Meaning (required):
Meaning (required):
As the above-named applicant I am making application for a Gold Star Family license plate. As part of this application
process, I am affirming that I meet the following criteria:
I am the surviving spouse, an ancestor, a descendant or a sibling of a person who died while in good
standing on active duty in the military service of the United States.
Date
Signature of Motor Vehicle Owner
Filing of a false application violates the provisions of the Motor Vehicle Registration Act. Any person that does so may be subject to prosecution and
cancellation of your certificate of registration.
Submit the completed application for approval to:
1HERO
Nebraska Department of Motor Vehicles
Driver and Vehicle Records Division
P.O. Box 94789
Gold Star Message
Lincoln, NE 68509-4789
Gold Star Numeric
PLEASE READ CAREFULLY
Revised 12/2020
Relationship Clarification:
You must be:
a surviving spouse - whether remarried or not
an ancestor – including a stepparent
a descendant – including a stepchild
a foster parent or a person in loco parentis
sibling
of a person who died while in good standing on active duty in the military service of the United States to make application
for a Gold Star Family license plate.___________________________________________________________
OFFICE LOCATIONS FOR PLATE PICK-UP
LANCASTER
East
West
th
625 North 46
Street
500 West “O” Street
Lincoln, NE 68503
Lincoln, NE 68528
DOUGLAS
North
South
Midtown
Millard
Maple
th
th
th
th
7414 N 30
St
4202 S 50
St
411 N 84
St
5730 S 144
St
15335 W Maple
Omaha, NE 68112
Omaha, NE 68117
Omaha, NE 68114
Omaha, NE 68137
Omaha, NE 68112
______________________________________________________________________________________________________________________
Vehicle Information: Before an application can be processed, the applicant must have a Nebraska issued title on the vehicle. In the
event the vehicle is leased, the leasing company must have obtained the Nebraska issued title in their name. Non-resident military
must provide a copy of the vehicle’s current registration. Applicants applying for Gold Star Family license plates on more than one
vehicle must submit a separate application for each vehicle.
Fee: A check or money order in the appropriate amount must be included with your application or it will be returned to you
unprocessed. No refunds are allowed. A $30 processing fee is assessed for all returned checks. Gold Star Family license plate
renewal fees are due annually in the same month as your vehicle registration. All renewal fees are paid to your County Treasurer
Motor Vehicle Office. Please Note: If new plates are registered to a vehicle in a month other than the month the vehicle’s current
registration expires; the Gold Star Family license plate renewal fee will be required when the vehicle’s registration is due for renewal.
Selecting a Message
Be very sure that each choice listed is acceptable to you. Your first available choice will be processed.
Once your application has been processed, your message choice cannot be changed.
Maximum of 5 characters allowed including spaces. Message is centered unless indicated otherwise.
Alpha and numeric characters only. No punctuation marks or symbols of any kind are allowed.
Messages that conflict with present numbering system or a valid set of plates currently registered, will not be
processed.
Messages determined by the DMV to express, connote or imply objectionable, obscene or offensive words or
phrases will be rejected, or if already issued, recalled and cancelled.
Message availability may be checked at: https://dmv.nebraska.gov/services. Please note there is no guarantee
when a choice shows available that it is the message the applicant will receive.
Numeric License Plates
Individuals ordering a Gold Star Family Numeric license plate will receive the next available number. Requests for a specific number
cannot be accepted.
Once Application Is Approved: After the application has been processed, an approval letter is sent to the applicant. The letter
indicates the approved message or the number assigned if the application was for a consecutive number plate, the date the plates will
be available at the County Treasurer Motor Vehicle Office and telephone number to verify the Treasurer has received the plates.
Current plates and registration must be surrendered when the Gold Star Family license plates are registered. Additional fees for
production of the license plates and new registration will be charged. Applicant should allow 3 to 4 weeks for the plates to arrive at
their County Treasurer Motor Vehicle Office.
Revised 12/2020
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