Transcription of REG 195, Application for Disabled Person Placard or Plates
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REG 195, Application for Disabled Person Placard or Plates
REG 195 (REV. 1/2021) WWW1 of 3 Application FOR Disabled Person Placard OR PLATESIMPORTANT INFORMATION, DISCLOSURES AND CERTIFICATIONSUse this form to apply for a Disabled Person (DP) parking Placard or license Plates . Complete this form legibly in ink. Illegible, incomplete, and/or unsigned forms will be returned. Use an Application for Replacement Plates , Stickers, and Documents form (REG 156) to request replacement of a lost, stolen, or damaged Placard or Plates . Attention Disabled Veterans with a service-connected disability: You may be eligible for Disabled Veteran License Plates which exempts one vehicle from the payment of registration and license fees.
REG 195 (REV. 1/2021) WWW 3 of 3 APPLICATION FOR DISABLED PERSON PLACARD OR PLATES Important: this is page three of the application. Both pages two and three are required in order to process the application. SECTION 6 — MEDICAL PROVIDER’S CERTIFICATION OF DISABILITY (Print patient name in space provided below.) My patient, PATIENT NAME
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