Transcription of APPLICATION FOR MOBILITY-IMPAIRED PARKING PERMIT …
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APPLICATION FOR MOBILITY-IMPAIRED PARKING PERMIT …
APPLICATION FOR MOBILITY-IMPAIRED PARKING PERMIT North Dakota Department of Transportation, Motor Vehicle SFN 2886 (6-2021)MOTOR VEHICLE DIVISION ND DEPT OF TRANSPORTATION 608 E BOULEVARD AVE BISMARCK ND 58505-0780 Telephone (701) 328-2725 Website: MOBILITY-IMPAIRED License Plates - $5 fee required for EACH vehicle listed below - DO NOT SEND CASHThis option requires ONE current PARKING PERMIT . **Complete ONLY if you are requesting MOBILITY-IMPAIRED license BE COMPLETED BY APPLICANT (please print)Placard Number(s)For Motor Vehicle Use OnlyApplicant's Legal NameMailing AddressCity StateZip CodeTelephone NumberDriver's License NumberPermanent MOBILITY-IMPAIRED PARKING PERMIT ONLY - no fee requiredNumber of permits requested (maximum amount 2)License Plate NumberYear and Make of VehicleLicense Plate NumberYear and Make of VehicleDuplicate Permanent MOBILITY-IMPAIRED PARKING Permits - $3 EACH - DO NOT SEND CASHC hoose reason for Duplicate: Lost Stolen MutilatedList placard number you have in your possession _____If a law enforcement officer finds that the PERMIT is being improperly used, the officer may report to t
SFN 2886 (6-2021) Page 2 of 2. TO BE COMPLETED BY QUALIFIED MEDICAL PROVIDER (please print) NON-REVERSIBLE CONDITION. When the permit expires, the applicant will not need to have the qualified medical provider complete a new application.
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