[Iowa DOT] 411260 Group 12

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SPECIAL PLATE APPLICATION G-12

A copy of the official government or military document of receipt of the medal, honor, or service is required for this application.

A. APPLICANT INFORMATION:

B. VEHICLE TYPE & LICENSE PLATE MESSAGE (for Personalized Plates Only):

or

Choose Vehicle Type: Motorcycle/Small Trailer

C. GIFT SECTION:

If ordering as a gift, please complete this section. Choose gift style:

x

Additional Signatures Required

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