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KANSAS
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
TOPEKA, KANSAS 66626-0001

APPLICATION FOR DISABLED
VETERANS LICENSE PLATE

www.ksrevenue.org/dmv

ExpirationDate
Present License Plate Number

Month

Year

Name of Veteran
City

Address
Auto [

]

*Truck [

]

Truck Weight

, KS

ZIP

Veterans Claim #

Vehicle Information:
YearMake

Style

ID #

* The full registration fee will be charged for truck plates over 12M.
I certify to be the current registered owner of the above vehicle.
Owner's Hand Printed Name
DateSignature of Vehicle Owner

VETERANS ADMINISTRATION CERTIFICATION
I, the undersigned, certify that the above named veteran making application for veteran's registration is:
(Check appropriatebox)

Entitled to compensation for a 50% disability under laws administered by the Veterans
Administration of the Federal Government.
Having been granted a statutory award by the VeteransAdministration of the Federal
Government is entitled to compensation for the loss or permanent loss of use of one or both
feet, one or both hands or permanent vision impairment of both eyes.

RegionalDirector Veterans Administration

Address

City

INSTRUCTIONS
• Application must be signed by the vehicle owner applying for disabled veteran status.
• Application for Disabled Veteran licenseplate shall be made at the local county treasurer’s office.
• Owner will forward application (form TR-103) to the Regional Director of the Veterans Administration
for certification and appropriatesignatures.
• Any person who owns a motor vehicle and is responsible for the transportation of such veteran may
apply for a Disabled Veteran license plate.
• There are no registration fees associatedwith either the initial Disabled Veteran license plate
application or registration renewal.
• More that one Disabled Veteran license plate may be issued. ONLY the initial Disabled Veteran
license...