Form MV58 "State of Montana Application for Next of Kin of Deceased Personnel License Plate" - Montana

What Is Form MV58?

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 February 1, 2016;
  • 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 MV58 by clicking the link below or browse more documents and templates provided by the Montana Department of Justice.

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Download Form MV58 "State of Montana Application for Next of Kin of Deceased Personnel License Plate" - Montana

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STATE OF MONTANA APPLICATION FOR NEXT
OF KIN OF DECEASED PERSONNEL 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
Obtain supporting documentation (see sections 2G and 3D below)
Complete and sign this application
Mail completed application and supporting documents to: Montana Veterans Affairs Division
P.O. Box 5715
Helena MT 59604-5715
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 Next of Kin of
Deceased Personnel License Plate.
Questions regarding the application process may be directed to
lehall@mt.gov
or (406) 324-3740.
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 NEXT OF KIN OF DECEASED PERSONNEL LICENSE 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
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.
MV58 (2/16)
This form is available in alternate formats for people with disabilities.
STATE OF MONTANA APPLICATION FOR NEXT
OF KIN OF DECEASED PERSONNEL 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
Obtain supporting documentation (see sections 2G and 3D below)
Complete and sign this application
Mail completed application and supporting documents to: Montana Veterans Affairs Division
P.O. Box 5715
Helena MT 59604-5715
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 Next of Kin of
Deceased Personnel License Plate.
Questions regarding the application process may be directed to
lehall@mt.gov
or (406) 324-3740.
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 NEXT OF KIN OF DECEASED PERSONNEL LICENSE 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
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.
MV58 (2/16)
This form is available in alternate formats for people with disabilities.
READ BEFORE COMPLETING THIS APPLICATION
PRIVACY ACT STATEMENT
AUTHORITY: MCA 61-3-458; Code of Federal Regulations Title 32, Section 578.63
PRINCIPAL PURPOSE: To evaluate the applicant's eligibility to receive the Next of Kin of Deceased
Personnel 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 Next of Kin of
Deceased Personnel License Plate.
INFORMATION
Montana Code Annotated 61-3-458 authorizes the design and distribution of the Next of Kin of Deceased
Personnel 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 while serving on active duty or while assigned in an
Army Reserve or Army National Guard unit in a drill status. Please note that the law does not currently
extend this license plate option to other Reserve or Guard categories.
NOTE: Per Code of Federal Regulations criteria, deceased status must be as of March 29, 1973 (to present).
Page 2 of 2
Montana county and state authorities reserve the right to reject any form that has been altered.
MV58 (2/16)
This form is available in alternate formats for people with disabilities.
Page of 2