Transcription of Disabled Parking ID Card, Placard, Plate or Tab ...
1 XDisabled Parking Replacementof ID Card, Placard, Plate or TabUse this form to replace your Disabled Parking license Plate , license Plate with tab, ID card, or your Disabled Parking privilege has expired, a new application and authorization from your healthcare provider is required (see form TD-420-073, Disabled Parking Application for Individuals).Take this completed form and applicable fees, in a check or money order payable to Department of Licensing, to any vehicle licensing office or mail to:Application and IssuanceDepartment of LicensingPO Box 9043 Olympia, WA 98507-9043 Questions: Contact our Customer Care center at or the following Disabled Parking item because it was lost, stolen, destroyed, or mutilated (check all that apply): ID card Placard number (list all placard numbers): Disabled license Plate number (call or visit any vehicle licensing office for applicable fees): License Plate with Disabled Parking tab (call or visit any vehicle licensing office for applicable fees).
2 Applicant (individual with disability)PRINT or TYPE Name Date of birth (mm/dd/yyyy)AddressCity State ZIP code10-digit phone number EmailNOTE: The address you provide is used to update your Disabled Parking record update your vehicle or driver license address: Vehicle address go to or visit any vehicle licensing office. Driver license address go to or visit any driver licensing this section if signing for the applicantName RelationshipAddressCity State ZIP codeI declare under penalty of perjury under the law of Washington that the foregoing is true and correct.
3 Date and place (city or county) signed Signature of applicant or individual signing for the applicantAI-420-076 (R/12/21)WA
