Get Az Dot 96-0104 2018

Filling out the AZ DoT 96-0104 form for individual disability license plates or placards can be straightforward with the right guidance. This comprehensive guide will take you through each section of the form, providing clear instructions to assist you in completing it online.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of application you are submitting by checking only one box: 'Placard,' 'Plate,' or 'Both.' This choice will determine the subsequent sections of the application.
3. Provide the name of the person with a disability, including their first, middle, and last name. Make sure this is printed clearly.
4. Input the Arizona ID or driver license number of the person with a disability.
5. Fill out the Arizona street address, along with the city, state, and zip code. Ensure accuracy here as this information is crucial for identification purposes.
6. If the mailing address differs from the street address provided, fill in the mailing address, city, state, and zip code.
7. Provide a daytime phone number where the person with a disability can be reached. An email address is optional but can be helpful for communication.
8. If you are requesting a disability license plate, complete the section with the vehicle identification number (VIN), year, make, and current plate number of the vehicle owned or leased by the person with a disability.
9. The medical certification must be completed by an authorized health care professional. Enter their name, medical license or certification number, and contact information.
10. Select whether the placard is permanent or temporary. If temporary, remember that it must be recertified after six months.
11. The health care professional should sign and date the form. Note that a stamp is not acceptable.
12. If applicable, fill out the statement for out-of-state disability placards or plates.
13. Once all information is complete, save changes, download the form, print it, or share it as required. Ensure that you keep a copy of the completed form for your records.

Start completing your AZ DoT 96-0104 form online now to ensure a smooth application process.