APPLICATION FOR DISABILITY PARKING CERTIFICATE

A P P L I C A T I O N F O R D I S A B I L I T Y P A R K I N G C E R T I F I C A T EMINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICESFOR CENTRAL OFFICE USE ONLY445 Minnesota Street, St. Paul, MN 55101-5164 Phone: (651) 297-3377 Web: applicant have a Minnesota Identification Card?Is applicant a Minnesota Licensed driver?YesYesNoNoLicense/ID Number----Date of BirthFull Name (Please Print) Last, First and MiddleHas applicant ever had a Minnesota DISABILITY PARKING CertificateYesNoMinn. DISABILITY license plates?NoYesList CERTIFICATE and/or plate #:Check here if this APPLICATION is for two PARKING certificates*Check here if this APPLICATION is for a second PARKING CERTIFICATE *Two certificates are not an option if applicant has DISABILITY license platesLimit 2 per applicant without DISABILITY license INDIVIDUAL SECTION To be completed by or for the person with a disabilityStreet AddressCityStateZipPlease Explain:Other;DamagedStolenLostIf applying for replacement, check reason: CERTIFICATE Ty

To be completed by or for the person with a disability Signature: I hereby certify the above information is complete and accurate to the best of my knowledge. I also give permission to the ... You can refuse, however; DPS-DVS may consider your application incomplete and not issue a disability certificate.

Loading..

Tags:

  Certificate, Complete, Parking, Completed, Disability, Incomplete, Disability parking certificate

Information

Related search queries