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Get VT TA-VS-113 2011-2021

LL OR IT WILL BE RETURNED**  ANY MEDICAL CHARGES INCURRED ARE THE RESPONSIBILITY OF THE PATIENT PLEASE INDICATE REASON FOR THE EVALUATION Complete Sections A, B, D & E if you are selecting one of the four reasons below. See front and back of form.  Applying for a Vermont License/Permit  Department Request  School Bus Endorsement (Type II)  New/Update Medical Condition Complete ALL Sections if requesting a DISABLED PLACARD OR PLATES. See front and back of form.  Disabled Park.

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