Form HSMV83034 "Application for Military Service-Related License Plates" - Florida

What Is Form HSMV83034?

This is a legal form that was released by the Florida Department of Highway Safety and Motor Vehicles - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the Florida Department of Highway Safety and Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HSMV83034 by clicking the link below or browse more documents and templates provided by the Florida Department of Highway Safety and Motor Vehicles.

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Download Form HSMV83034 "Application for Military Service-Related License Plates" - Florida

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FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR MILITARY SERVICE-RELATED LICENSE PLATES
SUBMIT APPLICATION TO YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE OR LICENSE PLATE AGENT
www.flhsmv.gov/locations
ALL APPLICATIONS FOR MEDAL OF HONOR, SILVER STAR, DISTINGUISHED SERVICE CROSS, NAVY CROSS,
AIR FORCE CROSS, DISTINGUISHED FLYING CROSS, OR WORLD WAR II VETERAN MUST BE SUBMITTED TO THE DIVISION OF MOTORIST SERVICES
See Reverse Side of this form for Address, Provisions of Law, and Instructions
1.
I,
hereby certify that I am a legal resident of Florida, residing at
(Address)
(City)
(State)
(Zip)
and I am the registered owner of the following described motor vehicle:
YEAR
MAKE
CURRENT LICENSE PLATE NUMBER
TITLE NUMBER
VEHICLE IDENTIFICATION NUMBER
OW NER/LESSEE'S DATE OF BIRTH
SEX
OWNER/LESSEE'S DL NUMBER
OW NER/LESSEE’S EMAIL ADDRESS
2.
This is to certify that I,
, am applying (and providing proof of eligibility, as
listed below) for the following license plate as indicated:
Ex-Prisoner of War
Purple Heart
Medal of Honor
Pearl Harbor Survivor
US Paratrooper
Operation Iraqi Freedom
Operation Enduring Freedom
Gold Star
Veteran of US Armed Forces
Combat Infantry Badge
Combat Action Badge
Combat Medical Badge
Vietnam War Veteran
Korean War Veteran
Silver Star
Distinguished Service Cross
Navy Cross
Air Force Cross
Operation Desert Shield Veteran
Operation Desert Storm Veteran
Combat Action Ribbon
Distinguished Flying Cross
Woman Veteran
Air Force Combat Action Medal
Navy Submariner
World War II Veteran
Ex-Prisoner of W ar or Un-remarried
Proof from the US Government of being a legal ex-prisoner of war while in the service of the Armed Forces
Surviving Spouse of Ex-Prisoner of W ar
of the United States or as a civilian serving with the consent or authorization of the US Government.
Purple Heart Medal Recipient or
Un-remarried Surviving Spouse of Purple
Proof from the US Government of being a recipient of the Purple Heart Medal.
Heart Medal Recipient
Medal of Honor
Proof from the US Government of being a recipient of the Medal of Honor.
Proof of membership in the Pearl Harbor Survivors Association or proof of active military duty in Pearl Harbor
Pearl Harbor Survivor
on December 7, 1941.
Proof of completion of US Army Jump School or of being decorated as a parachutist during military training.
US Paratrooper
($20 annual use fee and $5 processing fee is required).
Proof of active or former military duty in Iraq during Operation Iraqi Freedom or in Afghanistan during Operation
Operation Iraqi Freedom
Enduring Freedom or proof the applicant was awarded the Iraq Campaign Medal, Afghanistan Campaign Medal,
Operation Enduring Freedom
or Global W ar on Terrorism Expeditionary Medal as appropriate.
Proof from the US Government that the service member was killed while serving and proof of relationship to
Gold Star
the service member.
Proof from the US Government of release or discharge from any branch of the United States Armed Forces.
Veteran of the United States Armed Forces
Proof from the US Government of being a recipient of the Combat Infantry Badge or proof of membership
Combat Infantry Badge
In the Combat Infantrymen’s Association, Inc., or other proof of being a recipient of the Combat Infantry Badge.
Proof from the US Government of being a recipient of the Combat Action Badge, or other proof of being a
Combat Action Badge
recipient of the Combat Action Badge.
Proof from the US Government of being a recipient of the Combat Medical Badge, or other proof of being a
Combat Medical Badge
recipient of the Combat Medical Badge.
Proof from the US Government of being deployed and serving in Vietnam during the military deployment in
Vietnam W ar Veteran
Indochina. Proof that the applicant was awarded the Vietnam Service Medal.
Proof from the US Government of being deployed and serving in Korea during the military deployment in Korea.
Korean W ar Veteran
Proof that the applicant was awarded the Korean Service Medal.
Navy Cross
Distinguished Service Cross
Proof from the US Government of being a recipient of the Navy Cross, Distinguished Service Cross, Silver Star,
Silver Star
Air Force Cross
or Air Force Cross.
Proof from the US Government that a current or former member was deployed and served in Saudi Arabia,
Operation Desert Shield Veterans
Kuwait, or another area of the Persian Gulf during Operation Desert Shield or Operation Desert Storm or proof
Operation Desert Storm Veterans
the applicant was awarded the Southwest Asia Service Medal.
HSMV 83034 - REV. 01/20
FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES
APPLICATION FOR MILITARY SERVICE-RELATED LICENSE PLATES
SUBMIT APPLICATION TO YOUR LOCAL COUNTY TAX COLLECTOR'S OFFICE OR LICENSE PLATE AGENT
www.flhsmv.gov/locations
ALL APPLICATIONS FOR MEDAL OF HONOR, SILVER STAR, DISTINGUISHED SERVICE CROSS, NAVY CROSS,
AIR FORCE CROSS, DISTINGUISHED FLYING CROSS, OR WORLD WAR II VETERAN MUST BE SUBMITTED TO THE DIVISION OF MOTORIST SERVICES
See Reverse Side of this form for Address, Provisions of Law, and Instructions
1.
I,
hereby certify that I am a legal resident of Florida, residing at
(Address)
(City)
(State)
(Zip)
and I am the registered owner of the following described motor vehicle:
YEAR
MAKE
CURRENT LICENSE PLATE NUMBER
TITLE NUMBER
VEHICLE IDENTIFICATION NUMBER
OW NER/LESSEE'S DATE OF BIRTH
SEX
OWNER/LESSEE'S DL NUMBER
OW NER/LESSEE’S EMAIL ADDRESS
2.
This is to certify that I,
, am applying (and providing proof of eligibility, as
listed below) for the following license plate as indicated:
Ex-Prisoner of War
Purple Heart
Medal of Honor
Pearl Harbor Survivor
US Paratrooper
Operation Iraqi Freedom
Operation Enduring Freedom
Gold Star
Veteran of US Armed Forces
Combat Infantry Badge
Combat Action Badge
Combat Medical Badge
Vietnam War Veteran
Korean War Veteran
Silver Star
Distinguished Service Cross
Navy Cross
Air Force Cross
Operation Desert Shield Veteran
Operation Desert Storm Veteran
Combat Action Ribbon
Distinguished Flying Cross
Woman Veteran
Air Force Combat Action Medal
Navy Submariner
World War II Veteran
Ex-Prisoner of W ar or Un-remarried
Proof from the US Government of being a legal ex-prisoner of war while in the service of the Armed Forces
Surviving Spouse of Ex-Prisoner of W ar
of the United States or as a civilian serving with the consent or authorization of the US Government.
Purple Heart Medal Recipient or
Un-remarried Surviving Spouse of Purple
Proof from the US Government of being a recipient of the Purple Heart Medal.
Heart Medal Recipient
Medal of Honor
Proof from the US Government of being a recipient of the Medal of Honor.
Proof of membership in the Pearl Harbor Survivors Association or proof of active military duty in Pearl Harbor
Pearl Harbor Survivor
on December 7, 1941.
Proof of completion of US Army Jump School or of being decorated as a parachutist during military training.
US Paratrooper
($20 annual use fee and $5 processing fee is required).
Proof of active or former military duty in Iraq during Operation Iraqi Freedom or in Afghanistan during Operation
Operation Iraqi Freedom
Enduring Freedom or proof the applicant was awarded the Iraq Campaign Medal, Afghanistan Campaign Medal,
Operation Enduring Freedom
or Global W ar on Terrorism Expeditionary Medal as appropriate.
Proof from the US Government that the service member was killed while serving and proof of relationship to
Gold Star
the service member.
Proof from the US Government of release or discharge from any branch of the United States Armed Forces.
Veteran of the United States Armed Forces
Proof from the US Government of being a recipient of the Combat Infantry Badge or proof of membership
Combat Infantry Badge
In the Combat Infantrymen’s Association, Inc., or other proof of being a recipient of the Combat Infantry Badge.
Proof from the US Government of being a recipient of the Combat Action Badge, or other proof of being a
Combat Action Badge
recipient of the Combat Action Badge.
Proof from the US Government of being a recipient of the Combat Medical Badge, or other proof of being a
Combat Medical Badge
recipient of the Combat Medical Badge.
Proof from the US Government of being deployed and serving in Vietnam during the military deployment in
Vietnam W ar Veteran
Indochina. Proof that the applicant was awarded the Vietnam Service Medal.
Proof from the US Government of being deployed and serving in Korea during the military deployment in Korea.
Korean W ar Veteran
Proof that the applicant was awarded the Korean Service Medal.
Navy Cross
Distinguished Service Cross
Proof from the US Government of being a recipient of the Navy Cross, Distinguished Service Cross, Silver Star,
Silver Star
Air Force Cross
or Air Force Cross.
Proof from the US Government that a current or former member was deployed and served in Saudi Arabia,
Operation Desert Shield Veterans
Kuwait, or another area of the Persian Gulf during Operation Desert Shield or Operation Desert Storm or proof
Operation Desert Storm Veterans
the applicant was awarded the Southwest Asia Service Medal.
HSMV 83034 - REV. 01/20
Proof of being a recipient of the Combat Action Ribbon. Proof may be on the member’s DD-214 or
Combat Action Ribbon
other military documents.
Distinguished Flying Cross
Proof of being a recipient of the Distinguished Flying Cross.
Woman Veteran
Proof of service from the United States Armed Forces. Proof may include a DD-214 or other
similar documents that show her service in the United States Military.
Air Force Combat Action Medal
Proof of being a recipient of the Air Force Combat Action Medal.
Navy Submariner
Proof of being a recipient of the Submariner designation.
World War II Veteran
Proof of service from the United States Armed Forces. The proof shall include service dates between
September 16, 1940 to July 24, 1947.
____________________________________________________
______________________
Signature of the applicant for the above indicated license plate
Applicant's phone number
PROVISIONS OF LAW:
Section 320.089, Florida Statutes, provides that the license plates specified on the reverse side of this form may only be issued to
the following types of vehicles:
Automobiles (private or lease).
Trucks for private use (weighing 7,999 pounds or less).
Motor homes or truck campers which are NOT "for hire" or "commercial" use.
INSTRUCTIONS:
Sections 1 and 2 on the reverse side of this form must be completed when requesting any of the Military Service-Related
License Plates. Fees may apply. The Florida Department of Highway Safety will contact the customer, using the address or
telephone number on this application, to provide the exact payment amount.
Application and documentation for Ex-Prisoner of War, Purple Heart, Pearl Harbor Survivor, US Paratrooper, Operation
Iraqi Freedom, Operation Enduring Freedom, Gold Star, Combat Infantry Badge, Combat Action Badge, Combat Medical
Badge, Vietnam War Veteran, Korean War Veteran, Operation Desert Storm Veteran, Operation Desert Shield Veteran,
Veteran of the United States Armed Forces, Combat Action Ribbon, and Woman Veteran license plates should be
processed at your local county tax collector’s office or license plate agent.
Application and documentation for Medal of Honor, Silver Star, Distinguished Service Cross, Navy Cross, Air Force Cross,
Distinguished Flying Cross, or World War II Veteran MUST be submitted to the Florida Department of Highway Safety for
processing. The mailing address is:
Florida Department of Highway Safety and Motor Vehicles
Direct Mail
2900 Apalachee Parkway, MS #72
Tallahassee, Florida 32399
Check your local phone book government pages or visit the following website for current mailing addresses:
w w w . f l h s m v . g o v / l o c a t i o n s
HSMV 83034 - REV. 01/20
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