Form DMV-41-TR at a glance
What it is: DMV-41-TR is the West Virginia Division of Motor Vehicles Parking Application for a Mobility Impaired Person.
Where and when to file: Mail to: Mobility Impaired Placards & Plates, PO Box 17030, Charleston, WV 25317.
All applicants must be West Virginia residents.
A filled-in Form DMV-41-TR example: a placard request signed by the applicant
How to fill out Form DMV-41-TR, box by box
Applicant Information
The mobility impaired person must enter their Social Security Number in the light gray box on the upper right corner of the page.
Enter the Name (LAST, FIRST, MIDDLE), the Phone, the Gender and the Birthdate.
Under Address, enter the STREET, CITY, STATE and ZIP.
Under Mailing Address (if different), enter the STREET, CITY, STATE and ZIP.
Plate and/or Placard Information
License plates can only be issued to an applicant whose name appears on the WV vehicle registration.
Request for a Mobility Impaired Plate or Placard: Is this request due to a LOST or STOLEN plate or placard? Please list the lost or stolen plate or placard number.
Vehicle and Insurance Information
The Vehicle and Insurance Information section is only required to be completed if this request is for a license plate.
Applicants requesting a mobility impaired license plate must be listed on the registration of the vehicle listed in Sub-Section C.
Enter the VIN/SERIAL NUMBER and the Policy No.
By signing you certify that you are a person with a mobility impairment which limits or impairs your ability to walk and that all of the information is accurate. Any false statement may result in legal penalties pursuant to West Virginia Code §17C-13-6. A parent or legal guardian may sign for the applicant if the applicant is unable to do so, and notes their relationship to the applicant.
More rules for Form DMV-41-TR
Licensed physician includes MD., DO., Chiropractor, Advanced Nurse Practitioner, and Physician's Assistant.
If a parking placard or special license plate has been lost, stolen, mutilated or destroyed, a replacement may be requested at any DMV Regional Office or by mail to the DMV in Charleston.
The customer must complete a new application but a doctor's recertification is not required.
When parked in a mobility impaired parking space, display the placard by hanging it on the rearview mirror, or, in the absence of a mirror post, on the dashboard.
It is unlawful to loan this placard to any person for any reason, regardless of whether that person is mobility impaired.
The mobility impaired person does not have to own or drive the vehicle to use the placard. Placard should be hung from the rearview mirror when parked but should be removed from the mirror when driving.
Common questions about Form DMV-41-TR
Who signs it?
The mobility impaired person completes Section 1 and signs the application. A licensed physician completes Section 2. Complete all of Part II. Failure to do so will result in this form being returned to the sender for completion.
Is there a deadline?
Permanent mobility impaired license plates expire each year or every other year.
Where do I file it?
Mail to: Mobility Impaired Placards & Plates, PO Box 17030, Charleston, WV 25317.
Are there fees?
The cost of a replacement placard is $5.00 (checked November 2, 2026).
Sources
[1] Form DMV-41-TR (Rev. 06/2023), Parking Application for a Mobility Impaired Person, West Virginia Division of Motor Vehicles (the Official source link on this page).