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Missioner of Safety Elizabeth A. Bielecki Director of Motor Vehicles APPLICATION FOR TINTED WINDOW MEDICAL WAIVER RSA 266:58-a, III-a and Saf-C 2500 Directions: This application must be filled out and signed by a medical doctor. The applicant must return the completed application, along with a photocopy of the vehicle registration(s) (up to 2 vehicles), to the DMV for processing. If approved, a Waiver will be mailed to the applicant. Applicant Information: Name: Date of Birth: Address: Stre.

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