Transcription of APPLICANT INFORMATION (person with disability)
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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.
TEMPORARY PLACARD (up to 6 months) DMV USE ONLY. ORIGINAL. REISSUE Placard Lost. Stolen. Destroyed/MutilatedReplacement. Placard ID. License Plate Placard. Placard ID. License PlateReplacement. APPLICANT INFORMATION (person with disability) FULL LEGAL NAME (last) (first) (middle) (suffix) DMV ASSIGNED NUMBER OR SOCIAL SECURITY …
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