MED 20: Virginia DMV Sun-Shading Medical Authorization Application

Check one: New Application (apply for sun-shading medical authorization) or Subsequent Application (add vehicle(s) to existing sun-shading medical authorization).

Enter the Vehicle Owner Name (print) and the DMV Customer Number.

Enter the Residence/Home Address, the Daytime Telephone Number, and the City, State and Zip Code.

Enter a Mailing Address, with its City, State and Zip Code, if it is different from the Residence/Home Address.

Identify each vehicle to be equipped with sun-shading material.

For each vehicle, enter the Year, Make, Model, Title Number, Identification Number (VIN) and License Plate Number.

Sign on the Applicant/Legal Guardian's Signature line and enter the Date (mm/dd/yyyy).

The vehicle owner acknowledges that Virginia Code §46.2-1053 only authorizes applying tint to the windows and windshield of the owner's motor vehicle(s) up to the total levels provided in the Sun Shading Allowances table, and that the law does not authorize darker tinting, even with a medical provider's recommendation.

The vehicle owner and the medical provider each certify and affirm that all information presented in this form is true and correct, that any documents presented to DMV are genuine, and that the information included in all supporting documentation is true and accurate.

Medical Provider Certification is required for new applications only, not subsequent applications.

Check the box that applies: Physician, Physician Assistant, Nurse Practitioner, Ophthalmologist or Optometrist.

Enter the Patient Name (print) and the Patient Birthdate (mm/dd/yyyy).

Enter the Medical Provider Name (print) and the License Number.

Enter the Business Address, City, State, Zip Code, Telephone Number and Fax Number.

Mark Yes or No for: Based on my examination, vehicle sun-shading is necessary for my patient's health. If yes, describe the medical condition that requires the use of sun-shading.

The medical provider acknowledges that Virginia Code §46.2-1053 only authorizes the application of tint to the windows and windshield of any motor vehicle up to the total levels provided in the Sun Shading Allowances table, and that any recommendation for darker tint will subject the vehicle and its owner to a Virginia Code violation.

For new applications only, not subsequent applications, the medical provider signs on the Medical Provider Signature line and enters the Date (mm/dd/yyyy).

To be eligible for sun-shading, as provided in Va Code §§ 46.2-1052 and 46.2-1053, the vehicle must be equipped with both left and right outside mirrors.

Windshield, total percentage of light transmittance allowed: no sun-shading allowed without medical authorization for regular passenger vehicles and multi-use passenger vehicles; with medical authorization, 35% - upper 5 inches to AS-1 line 70% windshield. Front Side Windows: 50% for regular passenger vehicles and 50% for multi-use passenger vehicles without medical authorization, and 35% with medical authorization.

Rear Side Windows and Rear Window, total percentage of light transmittance allowed: 35% for regular passenger vehicles and no limitations for multi-use passenger vehicles without medical authorization, and 35% with medical authorization.

Complete the form in its entirety and return it to any DMV customer service center, mail it to DMV, or fax it to (804) 367-1384.

The vehicle owner and the medical provider each make their certification and affirmation under penalty of perjury, and knowingly making a false statement or representation on this form is a criminal violation.