MEDICAL EXAMINER S CERTIFICATION OF MOBILITY IMPAIRMENT I certify that Name Birth Date Address Race/Sex City/State/Zip code meets the requirements as outlined in shown on reverse side and qualifies for a mobility impaired license plate/hang-tag. 4 G 4. PERMANENTLY IMPAIRED Applicant TEMPORARILY IMPAIRED Applicant has a temporary has a total or lifelong condition of mobility impairment from which little or no improvement or recovery can reasonably be expected. A medical examiner s certification is required on initial application only. Condition of mobility impairment from which improvement or recovery can reasonably be expected. Applicant is entitled to a hang-tag which will be valid for one 1 year. A medical examiner s cerification is required for renewal of hang-tag. UNABLE TO APPEAR IN PERSON AT OFFICE OF MOTOR VEHICLES Applicant must bring facial photo. Medical Examiner s Signature Date Printed Name of Medical Examiner State License Address Telephone TO BE COMPLETED BY MOTOR VEHICLE....
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the LA DPSMV1966 online
Filling out the LA DPSMV1966 form is a crucial step in obtaining a mobility impaired license plate or hangtag. This guide will walk you through each step of completing the form accurately and comprehensively, ensuring you have the necessary support throughout the process.
Follow the steps to successfully complete the LA DPSMV1966 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by providing the applicant’s full name in the designated field for certification. This name should correspond to the individual applying for the mobility impaired license plate or hangtag.
- Enter the date of birth of the applicant in the appropriate format. This information is essential to verify the identity of the applicant.
- Select the applicant's race as required. This information may help in processing, but it is not the primary concern of the application.
- Indicate the applicant’s gender in the specified field. Ensure that this detail is accurate.
- Provide the complete address of the applicant, ensuring to include the street, city, state, and zip code for accurate identification.
- Mark whether the applicant has a permanently impaired condition or a temporarily impaired condition by noting the relevant option. This will determine the type of mobility assistance they will receive.
- Have a medical examiner complete the section requiring their signature, printed name, state license number, and contact information. This certification is vital for the approval of the application.
- Once all fields are filled, review the document for any errors or missing information. Accuracy is key to avoiding delays.
- After confirming all details are correct, you may save changes, download the form, print it, or share it as needed.
Complete the LA DPSMV1966 form online today to ensure you receive the mobility assistance you need.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
You can download the Medical Examiner's Certification of Mobility Impairment form (DPSMV...
Get answers to your most pressing questions about US Legal Forms API.
Is handicap parking free in Louisiana?
It allows for any car with a license plate, hang tag or special parking card “impaired mobility” designation to park free in metered spaces for up to 3 hours. The vehicles have to be transporting the person with disabilities at the time to qualify.
What is a Louisiana mobility impaired ID card for?
Mobility Impaired Hang Tags (Handicapped Hang Tags) can be issued to anyone having a Medical Examiner's Certification verifying that the applicant is Mobility Impaired or, in the case of a Disabled Veteran, a decision letter or an affidavit from the Veterans Affairs Office attesting to the Veteran's disability.
How much does it cost for a handicap license plate in Louisiana?
In Louisiana, the price for handicap plates is $10. The plates are valid for two years. You'll also pay a fee of around $8 for any plate-related transaction with the exception of renewals. You'll also pay a $3 fee for all handicap placards, whether the placards are temporary permanent, lost, damaged or stolen.
How much is a handicap tag in Louisiana?
There is a $3.00 fee for all placards, including permanent, temporary, renewal, lost, stolen, or damaged.
Can you park free at a meter with a handicap placard in Louisiana?
Travelers with legal handicap credentials are permitted to park in metered spaces for free for up to three hours. For questions and parking information, call 504-658-8200.
What form is needed for a handicap tag in Louisiana?
To obtain a hang tag for a mobility-impaired person, the following must be submitted to the OMV: A Physician's Certification of Mobility Impairment form (for handicap placards and license plates), DPSMV 1966, which has been completed by the mobility impaired individual's physician.
Can I renew my handicap placard online in Louisiana?
Residents can only apply for a Louisiana handicap tag by visiting their local Office of Motor Vehicles office. You will need to: Complete the Louisiana DMV handicap form and application provided to you.
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.