Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in an editor for online completion.
2. In the applicant section, print or type your name, including last name, first name, and middle initial. Provide your date of birth in the format mm/dd/yyyy and enter your mailing address, including PO Box or street address and apartment number if applicable.
3. Complete the contact information by providing a 10-digit daytime phone number, email address, city, state, and ZIP code. If you have a current license plate, include that as well.
4. Indicate the registration expiration date if applicable, and sign the application. You or an authorized representative must provide a signature in the designated area.
5. Choose your parking privilege options. Your healthcare provider will determine whether you receive a temporary or permanent disabled parking permit. Select the appropriate option for temporary or permanent status and specify the number of placards if applicable.
6. The healthcare provider section must be completed by a doctor, physician, or licensed registered nurse practitioner. They will print or type their name, professional classification, and office address. They will also indicate whether the duration of the privilege is permanent or temporary.
7. The healthcare provider must specify the qualifying condition of the applicant. Options include various mobility-related limitations. The provider will certify this information under penalty of perjury.
8. Lastly, the healthcare provider should sign and date the application in the designated areas, ensuring all necessary authorizations are included. Return the application along with the signed authorization to the applicant.
9. Once all sections are completed, review your application for accuracy. Save changes, download, print, or share the form per your needs.

Complete your Disabled Parking Application online now to secure your parking privileges.