"Application for Purple Heart License Plate" - Nebraska

Application for Purple Heart License Plate 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;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • 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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Download "Application for Purple Heart License Plate" - Nebraska

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APPLICATION FOR
PURPLE HEART LICENSE PLATE
§60-3,125
Applicant Information
Vehicle Information
Name
VIN
Address
Make
Year
City
State NE Zip
County of Registration
Co #
Email Address
Title Number
Daytime Phone (
)
Is vehicle leased?
Yes
No
Applicant’s name must appear on the Nebraska
IMPORTANT:
Lessor
Certificate of Title or, in the event the vehicle is leased or non-resident
military, the registration of the vehicle. Non-resident military must
Motor vehicles, motorcycles, trailers, semitrailers and cabin trailers are
include a copy of their registration with this application.
eligible for a Purple Heart License Plate.
If a resident of Douglas or Lancaster County, office location where plates will be picked up: __________________
Check here if you currently have a Purple Heart
License Plate registered to one or more vehicles and are
requesting an additional plate.
Indicate currently registered Purple
Heart License Plate Number:
Motorcycle
Trailer/Semitrailer
Motor Vehicle
Cabin Trailer
NOTE: A separate application must be submitted for
each Purple Heart License Plate requested.
As the above-named applicant I am making application for a Purple Heart license plate. As part of this application process, I am
providing the following information (check all boxes that apply to you and provide the required information):
I have received an award of a Purple Heart from the federal government.
I own or lease the above-named motor vehicle or trailer and my name does appear on the certificate of title and/or
registration.
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.
Once the application is approved, the applicant will receive written notification that must be presented to the County Treasurer Motor
Vehicle Office in the applicant’s county of residence before the plate may be registered. All required registration fees and taxes due at
the time of registration apply____________________________________________________________________________________
OFFICE LOCATIONS FOR PLATE PICK-UP
LANCASTER
East
West
500 West “O” Street
th
625 North 46
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 68116
Submit the completed application for approval to:
A Purple Heart Plate does not afford the registered owner of any
special parking privileges.
Nebraska Department of Motor Vehicles
~
Driver and Vehicle Records Division
For questions related to the application please contact this office at
P.O. Box 94789
402.471.3918.
Lincoln, NE 68509-4789
Revised 10/2019
Printed on Recycled Paper
APPLICATION FOR
PURPLE HEART LICENSE PLATE
§60-3,125
Applicant Information
Vehicle Information
Name
VIN
Address
Make
Year
City
State NE Zip
County of Registration
Co #
Email Address
Title Number
Daytime Phone (
)
Is vehicle leased?
Yes
No
Applicant’s name must appear on the Nebraska
IMPORTANT:
Lessor
Certificate of Title or, in the event the vehicle is leased or non-resident
military, the registration of the vehicle. Non-resident military must
Motor vehicles, motorcycles, trailers, semitrailers and cabin trailers are
include a copy of their registration with this application.
eligible for a Purple Heart License Plate.
If a resident of Douglas or Lancaster County, office location where plates will be picked up: __________________
Check here if you currently have a Purple Heart
License Plate registered to one or more vehicles and are
requesting an additional plate.
Indicate currently registered Purple
Heart License Plate Number:
Motorcycle
Trailer/Semitrailer
Motor Vehicle
Cabin Trailer
NOTE: A separate application must be submitted for
each Purple Heart License Plate requested.
As the above-named applicant I am making application for a Purple Heart license plate. As part of this application process, I am
providing the following information (check all boxes that apply to you and provide the required information):
I have received an award of a Purple Heart from the federal government.
I own or lease the above-named motor vehicle or trailer and my name does appear on the certificate of title and/or
registration.
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.
Once the application is approved, the applicant will receive written notification that must be presented to the County Treasurer Motor
Vehicle Office in the applicant’s county of residence before the plate may be registered. All required registration fees and taxes due at
the time of registration apply____________________________________________________________________________________
OFFICE LOCATIONS FOR PLATE PICK-UP
LANCASTER
East
West
500 West “O” Street
th
625 North 46
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 68116
Submit the completed application for approval to:
A Purple Heart Plate does not afford the registered owner of any
special parking privileges.
Nebraska Department of Motor Vehicles
~
Driver and Vehicle Records Division
For questions related to the application please contact this office at
P.O. Box 94789
402.471.3918.
Lincoln, NE 68509-4789
Revised 10/2019
Printed on Recycled Paper