I understand that by submitting this form i have read the front and back of this form and agree to take. Notary or mvd agent signature date county state commission expires : Web complete the information below, only if requesting a disability license plate. You'll need this form, which can be found on the adot website or at any local motor vehicle division (mvd) office. If your selection requires additional documentation and you are unable to order online you may fill out a special plate application.

Web there is no fee for a disability placard. Web complete the information below, only if requesting a disability license plate. Web download the form: Must be signed by an arizona physician, registered nurse, nurse practitioner, audiologist, or hospital administrator.

Fill out the applicant and vehicle information sections of the form. I understand that by submitting this form i have read the front and back of this form and agree to take. Web placard type disability parking placard hearing impaired placard.

Applicant name (person with a disability or hearing impaired or organization) phone ( ) date of birth. You can access the application by going to your local arizona motor vehicle division (mvd) office or printing the document online. If you lease your vehicle, you must present the lease document with your name on it. Vehicle identification number (vin) year make current plate number. Have your healthcare provider complete the medical certification section of the form.

Applicant name (person with a disability or hearing impaired or organization) phone. Recipients must complete a deaf / hard of hearing plate/placard application or have one on file. Have your healthcare provider complete the medical certification section of the form.

Visit Any Mvd Office Or Authorized Third Party Office, Or Write To Request Disability Plates And Placards.

Web placard type disability parking placard hearing impaired placard. To apply for a disability plate or placard (both permanent and temporary), to add a disability symbol to a special license plate, or for a hearing impaired license plate or placard. Notary or mvd agent signature date county state commission expires : The vehicle must be owned or leased by the person with a disability or hearing impairment.

Web For Eligibility See Reverse Side Of The Application.

Web select and order personalized and specialty plates online at azmvdnow.gov. Web how do i renew a disability placard? To apply for a disability plate or placard (both permanent and temporary), to add a disability symbol to a special license plate, or for a hearing impaired license plate or placard. Web please read all the requirements on this form.

Web There Is No Fee For A Disability Placard.

Recipients must complete a deaf / hard of hearing plate/placard application or have one on file. Have your healthcare provider complete the medical certification section of the form. Applicant name (person with a disability or hearing impaired or organization) phone. A postage and handling fee is required for a disability plate.

Disability Plate Requests Are Not Available Online, Paper Form Required (See Page 2) Please Visit Our Website For Special Plate Maximum Number Of Characters And Recipient Information.

Update address & contact info. If your selection requires additional documentation and you are unable to order online you may fill out a special plate application. Web download the form: If you own or lease a vehicle, you can also apply for a handicap license plate.

If you own or lease a vehicle, you can also apply for a handicap license plate. The application must include medical certification from a licensed physician. Notary or mvd agent signature date county state commission expires : Applicant name (person with a disability or hearing impaired or organization) phone. The vehicle must be owned or leased by the person with a disability or hearing impairment.