"Request for Gold Star Family License Plate" - Arkansas

Request for Gold Star Family License Plate is a legal document that was released by the Arkansas Department of Finance & Administration - a government authority operating within Arkansas.

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STATE OF ARKANSAS
OFFICE OF MOTOR VEHICLES
REQUEST FOR GOLD STAR FAMILY LICENSE PLATE
Special Gold Star Family license plates are issued at no charge under Arkansas Code 27-24-309.
This section provides that, in order to be eligible for this special plate, the applicant must be the
Spouse, parent or sibling of a member of the armed forces of the United States, killed in a conflict
recognized by the United States Department of Defense, and who has received a Gold Star Lapel
Button issued by the United States Department of Defense.
Indicate if parent, spouse or sibling by checking the appropriate box below:
Spouse
Parent
Sibling
Following are requirements for a Special Gold Star Family license plate:
Submit this form signed and dated;
The applicant must present a copy of the Report of Casualty DD1300 form, which will be
forwarded by the Revenue Office to the Office of Motor Vehicle to be kept on file;
If spouse, the applicant must present a copy of marriage certificate reflecting applicant’s
marriage to deceased veteran, or if a parent, a copy of birth certificate reflecting that applicant
is a parent of the deceased veteran;
The eligible applicant must be listed as owner or a co-owner on the certificate of title and
registration of the motor vehicle to which the Special Gold Star Family license plate will be
issued;
Under Arkansas Code 27-24-309, no more than one (1) Gold Star Family license plate may
be issued to an eligible applicant.
CERTIFICATION OF APPLICANT
I certify, under penalty of perjury, that, as stated above, I am the spouse or parent of a member of the
United States Armed Forces, killed in action in a conflict recognized by the United States Department
of Defense. I have received a Gold Star Lapel Button issued by the United States Department of
Defense and I am supplying the Arkansas State Revenue Office with a copy of the Form DD1300 from
the United States Department of Defense.
Printed Name of Applicant
Signature of Applicant
Date
STATE OF ARKANSAS
OFFICE OF MOTOR VEHICLES
REQUEST FOR GOLD STAR FAMILY LICENSE PLATE
Special Gold Star Family license plates are issued at no charge under Arkansas Code 27-24-309.
This section provides that, in order to be eligible for this special plate, the applicant must be the
Spouse, parent or sibling of a member of the armed forces of the United States, killed in a conflict
recognized by the United States Department of Defense, and who has received a Gold Star Lapel
Button issued by the United States Department of Defense.
Indicate if parent, spouse or sibling by checking the appropriate box below:
Spouse
Parent
Sibling
Following are requirements for a Special Gold Star Family license plate:
Submit this form signed and dated;
The applicant must present a copy of the Report of Casualty DD1300 form, which will be
forwarded by the Revenue Office to the Office of Motor Vehicle to be kept on file;
If spouse, the applicant must present a copy of marriage certificate reflecting applicant’s
marriage to deceased veteran, or if a parent, a copy of birth certificate reflecting that applicant
is a parent of the deceased veteran;
The eligible applicant must be listed as owner or a co-owner on the certificate of title and
registration of the motor vehicle to which the Special Gold Star Family license plate will be
issued;
Under Arkansas Code 27-24-309, no more than one (1) Gold Star Family license plate may
be issued to an eligible applicant.
CERTIFICATION OF APPLICANT
I certify, under penalty of perjury, that, as stated above, I am the spouse or parent of a member of the
United States Armed Forces, killed in action in a conflict recognized by the United States Department
of Defense. I have received a Gold Star Lapel Button issued by the United States Department of
Defense and I am supplying the Arkansas State Revenue Office with a copy of the Form DD1300 from
the United States Department of Defense.
Printed Name of Applicant
Signature of Applicant
Date