Transcription of APPLICANT INFORMATION (person with disability)
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Example: dental hygienist
APPLICANT INFORMATION (person with disability)
MED 10 (02/10/2018) disabled parking placard OR LICENSE PLATES APPLICATION HP PLATESPERMANENT placard (5 years)RENEWAL (No medical professional certification required.)ORIGINAL (Medical professional certification required.)REISSUE Lost StolenDestroyed/MutilatedORIGINAL PLATES submit completed form VSA 10 DUPLICATE PLATES Destroyed LostREISSUE PLATES Plates never received Unreadable (letters/numbers unclear) I understand that misuse, counterfeiting, or alteration of disabled placards may result in fines up to $ and up to 6 months in jail and/or revocation of disabled parking privileges. I certify that I have a (check one): disability that limits or impairs my ability to walk or creates a safety concern while walking. I also understand that the disabled parking placard or plates issued to me cannot be loaned to anyone, including family members or friends, to benefit a person other than myself.
DISABLED PARKING PLACARD MED 10 (02/10/2018) . OR LICENSE PLATES APPLICATION . HP PLATES. PERMANENT PLACARD (5 years) RENEWAL (No medical professional certification required.)
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