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Get VA 32584 1997-2024

DEPARTMENT OF VETERANS AFFAIRS 302 West Washington Street Room E-120 Indianapolis Indiana 46204-2738 State Form 32584 R4/3-97 Telephone Fax CERTIFICATION LICENSE OF ELIGIBILITY FOR VETERAN 317/232-3910 317/232-7721 PLATES Veteran s Name Street Address City State VA Claim Number Zip Social Security Number I request certification for the following license plate Disabled Ex-POW Purple Heart Veteran s Signature Authorizes the release of information to confirm eligibility Once the application is completed either send or fax it to the Indiana Department of Veterans Affairs address and fax numbers listed above. The Purple Heart license plate application must have documentation with the application* Approved applications are returned only by mail they cannot be faxed back to the applicant. You do not need to reapply for certification once this form has been approved except for the Disabled Veteran license plate and then only if your disability status changes. The Hoosier Veteran license plate may be approved at your local license branch and does not require a form* You must present your DD 214 or discharge showing an honorable or under honorable conditions discharge. DO NOT WRITE BELOW THIS LINE To be completed by Indiana Department of Veterans Affairs None of the approved by the Indiana without the veteran license plates below may be issued without this form as the Indiana Department of Veterans Affairs. Forms approved by embossed seal are not valid* According to records available the above-named veteran is /is not entitled to the license plate s indicated below Class I - 100 Disabled Veteran Veteran Class II - Disabled Ex-POW Approving Authority Signature Date. The Purple Heart license plate application must have documentation with the application* Approved applications are returned only by mail they cannot be faxed back to the applicant. You do not need to reapply for certification once this form has been approved except for the Disabled Veteran license plate and then only if your disability status changes. You do not need to reapply for certification once this form has been approved except for the Disabled Veteran license plate and then only if your disability status changes. The Hoosier Veteran license plate may be approved at your local license branch and does not require a form* You must present your DD 214 or discharge showing an honorable or under honorable conditions discharge. The Hoosier Veteran license plate may be approved at your local license branch and does not require a form* You must present your DD 214 or discharge showing an honorable or under honorable conditions discharge. DO NOT WRITE BELOW THIS LINE To be completed by Indiana Department of Veterans Affairs None of the approved by the Indiana without the veteran license plates below may be issued without this form as the Indiana Department of Veterans Affairs. DO NOT WRITE BELOW THIS LINE To be completed by Indiana Department of Veterans Affairs None of the approved by the Indiana without the veteran license plates below may be issued without this form as the Indiana Department of Veterans Affairs. Forms approved by embossed seal are not valid* According to records available the above-named veteran is /is not entitled to the license plate s indicated below Class I - 100 Disabled Veteran Veteran Class II - Disabled Ex-POW Approving Authority Signature Date. .

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