My tag is issued by the state of Louisiana (we have dual residences in Arkansas and Louisiana but I get my medical care in LA). I've only had my tag for a year. It was extremely easy to get after my doctor signed the forms. I thought I might have to wait in line for hours (which one has to do for a driver's license), but it was very quick. But I do have to do it once a year as my doctor said they make it almost impossible to get a permanent tag. And I probably couldn't have gotten a permanent tag anyway as I register my car in Arkansas as the insurance rates are half of what they are in New Orleans.