Transcription of PennDOT - Form MV-145A
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PennDOT - Form MV-145A
ORIGINAL REQUEST - Permanent Placard Severely Disabled Veteran Temporary Placard qqqqqRENEWAL REQUEST - (For Permanent Placards Only)CHECK ( 4 ) APPROPRIATE BLOCKS BELOWqqREPLACEMENT REQUEST - PLACARD ID CARD Defaced Lost Stolen Never Received CHANGE OF ADDRESS/NAME AAPPLICANT INFORMATION - LIST NAME AND ADDRESS OF PERSON WITH DISABILITYBCERTIFICATION FROM A HEALTH CARE PROVIDER LICENSED OR CERTIFIED IN PA OR A CONTIGUOUS STATE (NEW YORK, NEW JERSEY,DELAWARE, MARYLAND, WEST VIRGINIA OR OHIO).
(Philadelphia or Pittsburgh) OR SERVICE UNIT IN WHICH THE VETERAN SERVED. E NOTARIZATION AND APPLICANT SIGNATURE - Applicant, natural parent or other authorized person listed in Section A must sign below. ... Bureau of Motor Vehicles • P.O. Box 68268 • Harrisburg, PA 17 0 6- 82 FOR TEMPORARY PLACARD ONLY: Please ... ordinances or police ...
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