Form VD-157 "Gold Star Family License Plate" - Vermont

What Is Form VD-157?

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

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Vermont Department of 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 VD-157 by clicking the link below or browse more documents and templates provided by the Vermont Department of Motor Vehicles.

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Download Form VD-157 "Gold Star Family License Plate" - Vermont

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Gold Star Family License Plate
DEPARTMENT OF MOTOR VEHICLES
120 State Street
Agency of Transportation
Montpelier, Vermont 05603-0001
802.828.2000
888-99-VERMONT
dmv.vermont.gov
Applicant Section (please completely fill out ALL of the following information):
Name:
Last
First
Middle
Address Where You Get Your Mail
(mailing address)
- Include Street Number and Name
City:
State:
Zip:
Name of Deceased Military Member:
Relationship to Deceased:
Daytime phone number
E-mail address
Current Plate #:
Plate Expires:
Vehicle Make:
Model:
Year:
Body Type:
I hereby affirm, under penalty of perjury, that the information on this form is true to the best of my knowledge. This declaration made under penalties of
23 VSA § 202 & § 4110.
Date:
Signature of
Applicant:
Send completed form with a copy of the DD-1300 to: (mail) Vermont Office of Veterans Affairs, 118 State St., Montpelier,
VT 05620-4401 or (fax) 802.828.5932.
DO NOT WRITE BELOW THIS LINE
My authorized signature and the Official Stamp of the Vermont Office of
Veterans Affairs certify the person named above as a Gold Star Family
Member per 10 U.S.C. § 1126.
Authorized Signature for Vermont Office of Veterans Affairs
(Not Valid Without Certified Stamp Above)
Statements and warrant herein are certified under penalty of 23 V.S.A. § 202 & 203.
DO NOT WRITE BELOW - DMV USE ONLY
Plate Style: N
Plate Issued:
231
465
Plate Type: R
Vehicle Type:
232
490P
CODE: 16
EXP:
Rater #:
RF = $
Old Plate #:
VD-157 10/2017 MTC
Gold Star Family License Plate
DEPARTMENT OF MOTOR VEHICLES
120 State Street
Agency of Transportation
Montpelier, Vermont 05603-0001
802.828.2000
888-99-VERMONT
dmv.vermont.gov
Applicant Section (please completely fill out ALL of the following information):
Name:
Last
First
Middle
Address Where You Get Your Mail
(mailing address)
- Include Street Number and Name
City:
State:
Zip:
Name of Deceased Military Member:
Relationship to Deceased:
Daytime phone number
E-mail address
Current Plate #:
Plate Expires:
Vehicle Make:
Model:
Year:
Body Type:
I hereby affirm, under penalty of perjury, that the information on this form is true to the best of my knowledge. This declaration made under penalties of
23 VSA § 202 & § 4110.
Date:
Signature of
Applicant:
Send completed form with a copy of the DD-1300 to: (mail) Vermont Office of Veterans Affairs, 118 State St., Montpelier,
VT 05620-4401 or (fax) 802.828.5932.
DO NOT WRITE BELOW THIS LINE
My authorized signature and the Official Stamp of the Vermont Office of
Veterans Affairs certify the person named above as a Gold Star Family
Member per 10 U.S.C. § 1126.
Authorized Signature for Vermont Office of Veterans Affairs
(Not Valid Without Certified Stamp Above)
Statements and warrant herein are certified under penalty of 23 V.S.A. § 202 & 203.
DO NOT WRITE BELOW - DMV USE ONLY
Plate Style: N
Plate Issued:
231
465
Plate Type: R
Vehicle Type:
232
490P
CODE: 16
EXP:
Rater #:
RF = $
Old Plate #:
VD-157 10/2017 MTC
Instructions
The Gold Star License Plate is a special motor vehicle license plate for Gold Star Families, as defined in 10 U.S.C. § 1126. These
license plates may be issued for use only on vehicles registered at the pleasure car rate or on trucks registered for less than
26,001 lbs. at the applicable fee. The plates shall be reissued only to the original holder of the plates.
These license plates will be issued bearing a distinctive number series, therefore, requests for “personalized” or vanity number
plates or Gold Star Family plate versions of ‘low number’ plates will not be accepted.
Original forms are not required. Faxed copies will be accepted as long as they contain the required certified stamp and authorized
signature.
Submit your completed application to the Vermont Office of Veterans Affairs for certification as a Gold Star Family member. The
Office of Veterans Affairs will forward the completed application and the copy of the DD form 1300 to the Department of Motor
Vehicles for processing.
If this is a new registration or a transfer of a registration, form VD-119, Vermont Registration, Tax
& Title Application must also be submitted. If this is a renewal, submit this completed application
along with your renewal notice and required fees.
Please provide all requested personal identification information. If the address indicated is different than our records we will
consider this a notification of change of mailing address for all your records.
Please provide all requested vehicle information. The renewal notice for the vehicle, Form TA-VD-100 or your Registration
Certificate will have the preprinted information required to complete Section 3. Please be sure to read your renewal notice and
provide the information and fees requested if also renewing your registration.
When completed attach a copy of the DD Form 1300, Report of Casualty, to this form and mail both forms to:
Vermont Office of Veterans Affairs, 118 State St., Montpelier, VT 05620-4401.
Applications submitted without certification by Vermont Office of Veterans Affairs or the signature of the applicant will be returned
to the applicant.
The Office of Veterans Affairs will forward the completed application and the copy
of the DD form 1300 to the Department of Motor Vehicles for processing. You may
request to have the Office of Veteran’s Affairs return this application and the DD
form 1300 to you so that you may bring this application to a DMV office or mail the
application to the DMV.
For information about motor vehicle registration and Gold Star Family license plates call the Vermont
Department of Motor Vehicles at (802) 828-2000.
For information about certification as a Gold Star Family and documentation required call the Vermont Office
of Veterans Affairs toll free (In Vermont) at 1-888-666-9844 or at (802) 828-3379 or (802) 828-3381; fax number
is (802) 828-5932.
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