Get Az Dot 96-0104 2018-2026
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How to fill out the AZ DoT 96-0104 online
The AZ DoT 96-0104 form is essential for individuals applying for a disability parking plate or placard in Arizona. This guide provides detailed, step-by-step instructions on how to fill out the form online, ensuring a smooth and efficient submission process.
Follow the steps to complete your application accurately.
- Press the ‘Get Form’ button to obtain the AZ DoT 96-0104 form and open it in your preferred online editor.
- Select the type of application you are submitting by checking only one box: Placard, Plate, or Both.
- Provide the name of the person with the disability in the designated field. Ensure to enter the first, middle, and last names clearly.
- Fill in the date of birth for the individual with the disability.
- Enter the Arizona ID or driver license number for verification.
- Complete the address fields with the Arizona street address, city, state, and zip code.
- If the mailing address differs from the physical address, provide the mailing address details as well.
- Fill in the daytime phone number and optional email address for contact purposes.
- If requesting a disability license plate, enter the vehicle identification number (VIN), year, make, and current plate number.
- Ensure that the medical certification section is filled out by an authorized health care professional, which must include their name, medical license or certification number, and contact number.
- The health care professional must confirm the individual's eligibility by checking the appropriate box for a permanent or temporary placard.
- Have the health care professional sign and date the form, as a signature is required for validation.
- Review all entries for accuracy and completeness before finalizing your application.
- Once all sections are complete, save your changes, and download or print the form as necessary for submission.
Complete your application for the AZ DoT 96-0104 online today and ensure you receive the necessary support!
To get a permanent handicap placard in Arizona, start by filling out form AZ DoT 96-0104. This form requires medical validation of your disability from an authorized healthcare provider. Once you have all needed signatures, submit the form to the AZ DoT for processing. Using a reliable platform like US Legal Forms can assist you in completing and submitting your application efficiently.
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