Form MV57 "State of Montana Application for Gold Star Family License Plate" - Montana

What Is Form MV57?

This is a legal form that was released by the Montana Department of Justice - a government authority operating within Montana. 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 Montana Department of Justice;
  • 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 MV57 by clicking the link below or browse more documents and templates provided by the Montana Department of Justice.

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Download Form MV57 "State of Montana Application for Gold Star Family License Plate" - Montana

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STATE OF MONTANA APPLICATION FOR GOLD
STAR FAMILY LICENSE PLATE
https://dojmt.gov/driving/plate-designs-and-fees/military/
To see the license plate, visit
** Before completing, read Privacy Act Statement and Information on page 2. **
INSTRUCTIONS
Montana Veterans Affairs Division
Obtain supporting documentation (see sections 2G and 3D below)
PO Box 5715
Complete and sign this application
Helena, MT 59604-5715
Mail completed application and supporting documents to:
Montana Veterans Affairs will verify the application/supporting documents and send the applicant a letter
showing eligibility. The letter must be presented to the applicant's County Treasurer's Office when requesting the Gold
taryn.phillips@mt.gov
Star Family License Plate. Questions regarding the application process may be directed to
or
(406) 324-3742.
1. APPLICANT RELATIONSHIP TO DECEASED SERVICEMEMBER
WIDOW
STEPFATHER
SON
DAUGHTER BY ADOPTION
WIDOWER
MOTHER THROUGH ADOPTION
DAUGHTER
BROTHER
MOTHER
FATHER THROUGH ADOPTION
STEPSON
SISTER
FATHER
FOSTER MOTHER IN LOCO PARENTIS
STEPDAUGHTER
HALF BROTHER
STEPMOTHER
FOSTER FATHER IN LOCO PARENTIS
SON BY ADOPTION
HALF SISTER
2. SERVICEMEMBER INFORMATION
A. NAME (Last, First, Middle Initial)
B. PAY GRADE OR RANK
C. SOCIAL SECURITY NUMBER
D. DATE OF DEATH (YYYYMMDD)
E. BRANCH OF SERVICE
F. GEOGRAPHICAL AREA OF SERVICE AT TIME OF DEATH
G. SUPPORTING DOCUMENTATION TO CONFIRM GOLD STAR FAMILY PLATE ELIGIBILITY
(Check the box that applies to the documentation attached to this application.)
DD Form 1300 - Report of Casualty
Death Notice
Other, please specify:
3. FAMILY MEMBER (APPLICANT) INFORMATION
Email:
Phone:
A. NAME (Last, First, Middle Initial)
B. NUMBER, STREET, AND APARTMENT NUMBER (if applicable)
C. CITY, STATE, AND ZIP CODE
D. SUPPORTING DOCUMENTATION TO VERIFY RELATIONSHIP TO DECEASED SERVICEMEMBER
(Check the box that applies to the documentation attached to this application.)
Birth Certificate
Marriage Certificate
Adoption Record
Other, please specify:
SIGNATURE OF APPLICANT
DATE
Page 1 of 2
Montana county and state authorities reserve the right to reject any form that has been altered.
MV57 (1/2020)
This form is available in alternate formats for people with disabilities.
STATE OF MONTANA APPLICATION FOR GOLD
STAR FAMILY LICENSE PLATE
https://dojmt.gov/driving/plate-designs-and-fees/military/
To see the license plate, visit
** Before completing, read Privacy Act Statement and Information on page 2. **
INSTRUCTIONS
Montana Veterans Affairs Division
Obtain supporting documentation (see sections 2G and 3D below)
PO Box 5715
Complete and sign this application
Helena, MT 59604-5715
Mail completed application and supporting documents to:
Montana Veterans Affairs will verify the application/supporting documents and send the applicant a letter
showing eligibility. The letter must be presented to the applicant's County Treasurer's Office when requesting the Gold
taryn.phillips@mt.gov
Star Family License Plate. Questions regarding the application process may be directed to
or
(406) 324-3742.
1. APPLICANT RELATIONSHIP TO DECEASED SERVICEMEMBER
WIDOW
STEPFATHER
SON
DAUGHTER BY ADOPTION
WIDOWER
MOTHER THROUGH ADOPTION
DAUGHTER
BROTHER
MOTHER
FATHER THROUGH ADOPTION
STEPSON
SISTER
FATHER
FOSTER MOTHER IN LOCO PARENTIS
STEPDAUGHTER
HALF BROTHER
STEPMOTHER
FOSTER FATHER IN LOCO PARENTIS
SON BY ADOPTION
HALF SISTER
2. SERVICEMEMBER INFORMATION
A. NAME (Last, First, Middle Initial)
B. PAY GRADE OR RANK
C. SOCIAL SECURITY NUMBER
D. DATE OF DEATH (YYYYMMDD)
E. BRANCH OF SERVICE
F. GEOGRAPHICAL AREA OF SERVICE AT TIME OF DEATH
G. SUPPORTING DOCUMENTATION TO CONFIRM GOLD STAR FAMILY PLATE ELIGIBILITY
(Check the box that applies to the documentation attached to this application.)
DD Form 1300 - Report of Casualty
Death Notice
Other, please specify:
3. FAMILY MEMBER (APPLICANT) INFORMATION
Email:
Phone:
A. NAME (Last, First, Middle Initial)
B. NUMBER, STREET, AND APARTMENT NUMBER (if applicable)
C. CITY, STATE, AND ZIP CODE
D. SUPPORTING DOCUMENTATION TO VERIFY RELATIONSHIP TO DECEASED SERVICEMEMBER
(Check the box that applies to the documentation attached to this application.)
Birth Certificate
Marriage Certificate
Adoption Record
Other, please specify:
SIGNATURE OF APPLICANT
DATE
Page 1 of 2
Montana county and state authorities reserve the right to reject any form that has been altered.
MV57 (1/2020)
This form is available in alternate formats for people with disabilities.
READ BEFORE COMPLETING THIS APPLICATION
PRIVACY ACT STATEMENT
AUTHORITY: MCA 61-3-458; 10 U.S.C. 1126
PRINCIPAL PURPOSE: To evaluate the applicant's eligibility to receive the Gold Star Family License Plate.
ROUTINE USE: To identify the applicant and establish a distribution record.
DISCLOSURE: Voluntary; however, if not provided, an eligible individual will not be issued the Gold Star Family License
Plate.
INFORMATION
Montana Code Annotated 61-3-458 authorizes the design and distribution of the Gold Star Family License Plate within the
State of Montana to qualified family members of members of the Armed Forces of the United States who lost their lives:
1. While engaged in an action against an enemy of the United States;
2. While engaged in military operations involving conflict with an opposing foreign force; or
3. While serving with friendly foreign forces engaged in an armed conflict in which the United States is not a belligerent
party against an opposing armed force.
Operations which are recognized by the Department of Defense in establishing eligibility for the Gold Star License Plate
include:
World War I, April 6, 1917 to March 3, 1921
World War II, September 8, 1939 to July 25, 1947
Korea, June 27, 1950 to July 27, 1954
Lebanon, July 1, 1958 to November 1, 1958
Republic of Vietnam, July 1, 1958 to March 28, 1973
Quemoy and Matsu Islands, August 23, 1958 to June 1, 1963
Taiwan Straits, August 23, 1958 to January 1, 1959
Congo, July 14, 1960 to September 1, 1962
Republic of Laos, April 19, 1961 to October 7, 1962
Berlin, August 14, 1961 to October 7, 1962
Cuba, October 24, 1962 to June 1, 1963
Congo, November 23, 1964 to November 27, 1964
Dominican Republic, April 28, 1965 to September 21, 1966
Korea, October 1, 1966 to June 30, 1974
Cambodia, March 29, 1973 to August 15, 1973
Thailand, March 29, 1973 to August 15, 1973
Cambodia, April 11, 1975 to April 13, 1975
Vietnam, April 29, 1975 to April 30, 1975
Mayaguez Operation, May 15, 1975
Lebanon, June 1983 to December 1, 1987
Grenada, October 23, 1983 to November 21, 1983
Operation Eldorado Canyon, April 2, 1986 to April 17, 1986
Panama, December 20, 1989 to January 31, 1990
Desert Shield/Desert Storm, August 2, 1990 to November 30, 1995
Haiti, September 16, 1994 to March 31, 1995
Somalia, December 5, 1992 to March 31, 1995
Persian Gulf, November 30, 1995 to (to be determined)
Former Republic of Yugoslavia, December 20, 1996 to June 20, 1998
Afghanistan, October 7, 2001 to (to be determined)
Iraq, March 19, 2003 to (to be determined)
And any subsequent operations as may be announced by the Secretary of Defense
Page 2 of 2
Montana county and state authorities reserve the right to reject any form that has been altered.
MV57 (1/2020)
This form is available in alternate formats for people with disabilities.
Page of 2