Form DR 2219 at a glance
What it is: Form DR 2219 is the Persons With Disabilities Parking Privileges Application of the Colorado Department of Revenue, Division of Motor Vehicles.
Who signs: Enter the Printed name as it appears on identification and sign the Signature of person with disability. To sign the Professional section, you must be a Professional as defined.
Persons With Disabilities must meet one of the criteria and have it verified in writing by a medical professional.
What to bring and attach to Form DR 2219
Submit a completed application in the name of the person with a disability.
Secure and verifiable identification for the person with a disability.
Power of Attorney appointing an agent.
Enclose a photocopy of the title or registration to the vehicle.
A filled-in Form DR 2219 example: an applicant fills out the identification page
How to fill out Form DR 2219, box by box
Name of person with disability and Date of Birth
Type or print in ink the Name of person with disability and the Date of Birth (MM/DD/YY).
Physical Address
Enter the Physical Address, City, State and ZIP Code.
Mailing Address (if different from above)
Enter the Mailing Address, City, State and ZIP Code only if the Mailing Address is different from the Physical Address.
Certification and signature
Certify, under penalty of perjury, that you have read and understand the Persons with Disabilities plate and placard application and usage requirements and that you are responsible for the use in conformity with Colorado Revised Statutes 42-3-204 and 42-4-1208.
Enter the Printed name as it appears on identification and sign the Signature of person with disability.
Violation of the requirements in Colorado Revised Statutes 42-3-204 and 42-4-1208 may result in fines and penalties up to $5,000, incarceration and community service, and suspension of Persons with Disabilities placards and plates. (checked November 2, 2026)
Secure and Verifiable ID of
Under Secure and Verifiable ID of, mark Applicant, Legal Guardian or Representative.
Type of ID, ID Number, Expires and Date of Birth
Under Type of ID, mark Colorado DL, Colorado ID, Identification document issued by United States Government, or Out of state DL or ID (Only for out of state residents applying for a short-term placard).
Enter the ID Number, when it Expires and the Date of Birth (MM/DD/YY).
Witness
The undersigned witness affirms that the Applicant, Legal Guardian or Entity Representative signing this document presented the identification described. Enter the Witness Printed Name, sign on Witness Signature and enter the Date (MM/DD/YY).
More rules for Form DR 2219
Please do not fax or e-mail the form to the Division of Motor Vehicles. The applicant must submit the completed DR 2219 at the time of registration.
If you make a mistake on this form, please complete a new form. Do not write over, white-out or cross-out information. This will void the form.
Complete the entire form, sign and date.
A plate or placard holder is responsible to safeguard the plate or placard from use by others.
You may contact the Title and Registration Sections at 303-205-5608 with any questions.
If your situation is different
Persons with Disabilities with Vehicle (Check one option below)
Persons with Disabilities with Vehicle: check one option: 1 Plate, 2 Plates, 1 Plate and 1 Placard, 1 Placard or 2 Placards.
Persons with Disabilities without a Vehicle (Check one option below)
Persons with Disabilities without a Vehicle: check one option: 1 Placard or 2 Placards.
Remuneration-Exempt Placard with Qualifying Disability (Check one option below)
Remuneration-Exempt Placard with Qualifying Disability: check one option: 1 Placard or 2 Placards.
Remuneration-exempt placard cannot be issued to a parent or guardian, child who is under 16 years of age, or business.
Short Term (90-Day) Disability
Short Term (90-Day) Disability: Short Term Temporary (90-Day) no fee Placard for persons with a short term disability to the degree described on page one of this form.
A 90-day temporary placard will be issued which is to be placed inside the vehicle of which the person with a disability is a passenger.
The placard is movable from one vehicle to another.
Out of state applicants can submit their out of state drivers license, identification document or United States Government identification document.
Section Completed by a Professional
This Section Must be Completed by a Professional Defined in Colorado Revised Statute 42-3-204(1)(a), (1)(i) and (i.5).
All criteria require certification by a person fully licensed to practice medicine in Colorado or a state that shares a common border with Colorado.
To sign the Professional section, you must be a Professional as defined.
This Person is Mobility Impaired (Check one box): persons who cannot walk two hundred feet without stopping to rest.
Persons who use portable oxygen.
Persons who cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device.
Persons who have a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.
Persons who are restricted by lung disease to such an extent that the person's forced (respiratory) expiratory volume for one second when measured by spirometry is less than one liter, or the arterial oxygen tension is less than sixty mm/hg on room air or at rest.
Persons who are severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition.
This impairment is: Permanent*, Extended*, Temporary*, Short Term (will last 90 days or less), or Remuneration-exempt qualifying disability*. *These Placards are valid for and must be renewed every 3 years. ** Chiropractors and Physical Therapists may only certify a physical impairment for Short Term Placards. Providers who knowingly misuse or who make false statements to help someone obtain or retain a placard may be fined up to $500,000 for a Class 4 Felony or $1,000 for a Class one misdemeanor. (checked November 2, 2026)
Impairments are defined as follows: Permanent: A condition that is not expected to change within a person's lifetime, given the current state of medical or adaptive technology. Extended: A condition that is not expected to change within thirty months after the issuance of an identifying figure, given the current state of medical or adaptive technology. Temporary: A condition that is expected to last less than thirty months after the issuance of an identifying plate or placard, given the current state of medical or adaptive technology. Short Term: A condition that is not expected to last more than 90 days after the issuance of a placard (can be renewed with medical professional's authorization).
Remuneration-exempt disability means a disability that limits an individual's: (i) fine motor control in both hands; (ii) ability to reach a height of forty-eight inches from the ground due to lack of strength or mobility in the individual's finger, hand, or upper extremity; or (iii) ability to reach or access a parking meter due to the use of a wheelchair or other ambulatory device.
The condition time is based on the date you enter (i.e., extended thirty-months is from the date entered, not the transaction date).
Common questions about Form DR 2219
Are there fees?
There is no fee for persons with disabilities placards. Standard registration fees and ownership taxes will be charged for disability license plates.
Sources
[1] Form DR 2219 (10/30/24), Persons With Disabilities Parking Privileges Application, Colorado Department of Revenue, Division of Motor Vehicles (the Official source link on this page).