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State of California
Veteran Status and
SECTION 1 - TO BE COMPLETED BY THE APPLICANT REQUESTING VETERAN STATUS AND/OR SERVICE CONNECTED DISABLITY VERIFICATION PRINT USING BLUE OR BLACK INK 
FIRST NAME
MIDDLE NAME
LAST NAME
SUFFIX
DRIVER LICENSE OR IDENTIFICATION NUMBER
STATE OF ISSUANCE
DATE OF BIRTH (MM/DD/YYYY)
EMAIL ADDRESS
DAYTIME TELEPHONE NUMBER
MAILING ADDRESS
CITY
STATE
ZIP CODE
RESIDENCE ADDRESS IF DIFFERENT FROM MAILING ADDRESS ABOVE
CITY
STATE
ZIP CODE
SECTION 2 - APPLICANT CERTIFICATION
I certify (or declare) under penalty of perjury under the laws of the State of California, that I have served in the United States uniformed services and received an other than dishonorable discharge, or served in a Guard or Reserve component and was mobilized for federal active duty. The information I provided is true and correct. I authorize County Veterans Service Office (CVSO) employees, officers, and designees to verify the documents presented.
APPLICANT SIGNATURE
_
DATE
SECTION 3 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE
COUNTY VETERANS SERVICE OFFICE ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
COUNTY
EMAIL ADDRESS
As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documentation required and that the above named individual meets the qualifications noted above.
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE
DATE
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME
TITLE
This form must be submitted in person to the Department of Motor Vehicles along with an application for a driver license or identification card in compliance with California Vehicle Code § 12811 (c)(5) and all requirements must be met prior to the issuance of a driver license or identification card with a veteran designation on the face of the card. In addition to any other fee, a $5 fee must be paid for the veteran designation.
SECTION 4 - |
DISABLED VETERAN CERTIFICATION FOR DISABLED VETERAN LICENSE PLATES |
|
|
TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR |
DESIGNEE |
The above named applicant is a disabled veteran who, as a result of injury or disease suffered while on active service with the armed forces of the United States, suffers from one or more of the following disabilities:
•Has a disability which has been rated at 100% by the United States Department of Veterans Affairs, due to a diagnosed disease or disorder which substantially impairs or interferes with mobility.
•Is so severely disabled as to be unable to move without the aid of an assistant device.
•Has lost, or has lost use of, one or more limbs.
•Has suffered permanent blindness, as defined in Section 19153 of the Welfare and Institutions Code.
SECTION 5 - TO BE COMPLETED BY AUTHORIZED COUNTY VETERANS SERVICE OFFICE EMPLOYEE, OFFICER, OR DESIGNEE
COUNTY VETERANS SERVICE OFFICE ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
COUNTY
EMAIL ADDRESS
As a representative of the County Veterans Service Office of the above named county, and designee of the California Department of Veterans Affairs, I certify under penalty of perjury under the laws of the State of California, that I have reviewed the documents
for the above named applicant that demonstrate that the applicant meets the qualifications noted above.
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S SIGNATURE
DATE
COUNTY VETERANS SERVICE OFFICE REPRESENTATIVE'S PRINTED NAME
TITLE
If this form is being submitted for an application for disabled veteran license plates only, this form and all other requirements, including acceptable proof of true full name and date of birth, may be submitted in person or by mail . For more information, please visit www.dmv.ca.gov.
FOR DMV USE ONLY
TECHNICIAN'S INITIALS/TECH ID #
DATELINE STAMP
APPLICANT'S DL/ID NUMBER
This form is not transferable |
Document Information
| Fact Name | Details |
|---|---|
| Form Purpose | The VSD 001 form is used to verify veteran status and service-connected disabilities in California. |
| Applicant Requirements | Applicants must have served in the U.S. uniformed services and received an honorable discharge. |
| Submission Method | This form must be submitted in person to the Department of Motor Vehicles (DMV). |
| Governing Law | California Vehicle Code § 12811 (c)(5) governs the submission of this form. |
| Fee for Veteran Designation | A $5 fee is required for the veteran designation on the driver's license or ID card. |
| Certification Under Penalty | Both the applicant and the County Veterans Service Office representative must certify under penalty of perjury. |
| Disabled Veteran License Plates | This form can also be used to apply for disabled veteran license plates. |
| Documentation Review | The County Veterans Service Office must review the applicant's documentation for verification. |
| Form Revision Date | The current version of the form is VSD-001, revised in January 2021. |
| Non-Transferability | This form is not transferable to another individual. |
Vsd 001 - Usage Guidelines
Filling out the VSD 001 form is a straightforward process that requires careful attention to detail. After completing the form, it will need to be submitted in person to the Department of Motor Vehicles (DMV) along with an application for a driver license or identification card. Ensure that all required information is accurate and complete to avoid any delays in processing.
- Begin by printing the form using blue or black ink.
- In Section 1, fill in your first name, middle name, last name, and suffix as applicable.
- Provide your driver license or identification number and the state of issuance.
- Enter your date of birth in the format MM/DD/YYYY.
- Include your email address and daytime telephone number.
- Fill in your mailing address, including city, state, and ZIP code.
- If your residence address is different from your mailing address, provide that information as well.
- In Section 2, read the certification statement carefully.
- Sign and date the form in the designated areas.
- Section 3 will be completed by an authorized County Veterans Service Office employee. Ensure they fill out their information correctly.
- If applying for disabled veteran license plates, Section 4 must also be completed by an authorized representative.
- Finally, review the entire form for accuracy before submission.
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Dos and Don'ts
When filling out the Vsd 001 form, attention to detail is essential. Here’s a list of things you should and shouldn’t do to ensure a smooth process.
- Do print using blue or black ink to maintain clarity.
- Do provide accurate personal information, including your full name and contact details.
- Do ensure that your signature is included in the certification section.
- Do verify that all required sections are completed before submission.
- Do submit the form in person at the DMV along with your application for a driver license or ID.
- Don’t leave any sections blank; incomplete forms can delay processing.
- Don’t use any ink color other than blue or black, as it may not be accepted.
- Don’t forget to pay the $5 fee for the veteran designation.
- Don’t submit the form without the required documentation for verification.
- Don’t assume that the form is transferable; it is specific to the applicant.
By following these guidelines, you can help ensure that your application process is efficient and successful.
Common mistakes
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Using the wrong ink color: Applicants should always use blue or black ink when filling out the VSD 001 form. Using other colors can lead to processing delays.
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Incomplete personal information: It is crucial to fill in all required fields, including first name, last name, date of birth, and contact details. Missing information can result in rejection of the application.
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Incorrect signature: The applicant must sign the form in the designated area. An unsigned form will not be accepted.
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Failure to certify: The applicant must certify the information provided is true and correct. Neglecting this step may lead to legal consequences.
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Not providing proper documentation: All necessary documents must be included for verification. Omitting any required documentation can delay the process.
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Ignoring submission guidelines: The form must be submitted in person to the DMV along with the application for a driver license or ID card. Not following these guidelines can lead to complications.
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Overlooking fees: A $5 fee is required for the veteran designation. Applicants should ensure this fee is paid to avoid processing issues.