Virginia VSA 10A – Gold Star / Next of Kin License Plate Certification

The VSA 10A is the official Virginia Department of Motor Vehicles (DMV) form used by immediate family members of military personnel who have died in service to request a special Gold Star or Next of Kin license plate. This commemorative plate honors the sacrifice of the fallen service member and provides a visible tribute on the road.

What Is the VSA 10A Form?

The VSA 10A, titled “License Plate Applicant Certification,” collects the applicant’s information, the deceased service member’s details, and a certification that the applicant is an immediate family member. Once approved, the DMV issues a Gold Star or Next of Kin plate at no additional cost.

Who Is Eligible?

• Parents, spouses, children, or siblings of a service member who died while on active duty.
• Legal guardians of a deceased service member.
• Anyone who can provide official proof of relationship and the service member’s death.

How to Complete the Form Online

Instead of downloading the PDF and editing it manually, simply click the "Fill out this form" button on this page. The Formize PDF Filler app will load the fillable VSA 10A document directly in your browser, allowing you to type, sign, and save without any extra software.

Common Mistakes to Avoid

• Leaving any required field blank – the DMV will reject incomplete submissions.
• Misspelling the deceased service member’s name or rank.
• Failing to attach supporting documents (military death certificate, proof of relationship).
• Signing the form with a stylus that does not create a digital signature; use the built‑in signature field in Formize.

Where to Submit Your Application

After completing the form online, you have two options:

1. In‑person: Bring the printed, signed form and supporting documents to any Virginia DMV customer service center.
2. Mail: Send the completed form and copies of all required documents to:
   Virginia Department of Motor Vehicles
   Vehicle Registration Division
   P.O. Box 27412
   Richmond, VA 23269.

Processing typically takes 7‑10 business days once the DMV receives a complete application.