Form 2769 at a glance
What it is: Form 2769 is the Application for Disabled Person Placard.
Who signs: A completed Application for Disabled Person Placard (Form 2769) signed by the disabled person, parent or legal guardian of the disabled person, or representative of an agency that transports disabled persons.
Any physically disabled person, parent or guardian of a physically disabled person, or a not-for-profit group or organization that transports physically disabled persons qualifies for a permanent or temporary disabled person placard.
The term physically disabled means a blind person, as defined in Section 8.700, RSMo, or a person with medical disabilities which prohibits, limits, or severely impairs one's ability to walk, as determined by an advance practice registered nurse, licensed physician, chiropractor, physician's assistant, podiatrist, physical therapist, occupational therapist, or optometrist as follows.
The person cannot walk 50 feet without stopping to rest due to a severe and disabling arthritic, neurological, orthopedic condition, or other severe and disabling condition.
The person cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device.
The person is restricted by a respiratory or other disease to such an extent that the person's forced respiratory volume for one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 mm/hg on room air at rest.
The person uses portable oxygen.
The person has a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to the standards set by the American Heart Association.
A person's age shall not be a factor in determining whether such person is physically disabled.
What to bring and attach to Form 2769
A completed and signed Physician's Statement for Disabled License Plates or Placards (Form 1776).
Is required every eight years for renewal applicants under the age of 75.
Is not required to obtain a replacement placard.
Any not-for-profit group, organization, or other entity that transports two or more physically disabled persons must submit a statement on business letterhead, signed by an officer that states the entity transports physically disabled persons.
Applicants may submit proof of disability in the form of a statement from the United States Veterans' Administration. When a statement from the United States Veterans' Administration verifying that the person is permanently disabled is supplied, the applicant shall not be required to provide physician's statements of physical disability for issuance or renewal of the license plate or windshield placard.
Upon approval of your application, you will receive a new placard and a validated registration receipt. Keep the registration receipt with you when using the placard.
A filled-in Form 2769 example: a disabled person renews a permanent placard
How to fill out Form 2769, box by box
Temporary Placard, Permanent Placard or Record Change Only
Mark one: Temporary Placard New, Renewal or Replacement; Permanent Placard New, Renewal or Replacement (No Fee); or Record Change Only Name Change or Address Change.
Do you currently have disabled license plate(s)?
Mark Yes or No for Do you currently have disabled license plate(s)?
Enter how many disabled placards you currently have.
Enter the current disabled license plate or placard number.
State the reason an additional disabled placard is needed if requesting more than one placard.
Replacement placard: Lost, Stolen, Mutilated, Destroyed or Never Received
If replacement placard is required, select one of the following (Notary Required): Lost, Stolen, Mutilated, Destroyed, Never Received (Replace at no fee).
Enter the lost, stolen, multilated, or destroyed placard number (recorded on signed receipt).
Applicant Information
Applicant Information: Enter the Legal Name of Disabled Person (Last, First, Middle) or Business.
Enter the Driver License Number or Federal Employer Identification Number, Date of Birth (MM/DD/YYYY) and Gender.
Enter the Street Address, City, State and Zip Code.
Mail To - If different than above
Under Mail To - If different, enter the Name, Telephone Number, Street Address, City, State and Zip Code.
I hereby certify that I am
Select All That Apply: I hereby certify that I am a disabled person, a disabled veteran, the parent or guardian of a disabled person, a representative of an agency that transports disabled persons, or 75 years old or older and am not required to submit a physician's statement at time of renewal.
Signature of Applicant, Telephone Number and Date
Enter the Signature of Applicant, Telephone Number and Date (MM/DD/YYYY).
Any false statement is a violation of the law and may be punished by fine imprisonment, or both. Fraudulent application, renewal, issuance, procurement, or use of disabled person license plates or windshield placards is a misdemeanor.
Notary Information - Required for replacements only
Notary Information - Required for replacements only.
Subscribed and sworn before me, this day of year, State, County (or City of St. Louis) and My Commission Expires (MM/DD/YYYY).
Notary Public Signature and Notary Public Name (Typed or Printed).
Embosser or black ink rubber stamp seal.
License Office notary service - $2.00. (checked October 20, 2026)
More rules for Form 2769
Form 2769 (Revised 09-2026): A permanent or temporary disabled person placard is a removable windshield placard that is to be hung from the front, middle rearview mirror of a parked vehicle in order to park in disabled parking spaces.
It is unlawful to hang the placard from the rearview mirror when driving the vehicle.
The driver or any occupant shall produce the validated receipt of this application and photo identification of the disabled person for whom the placard was issued upon request from any law enforcement or peace officer.
A placard is not transferable to another person. It is unlawful for the placard owner to loan the placard to any person for any reason, even if that person is disabled.
An advance practice registered nurse, licensed physician, chiropractor, physician's assistant, podiatrist, physical therapist, occupational therapist, or optometrist must certify the person is permanently or temporarily physically disabled by completing a Physician's Statement for Disabled Person's Placard (Form 1776) and indicating whether the disability is permanent or temporary. Proof of permanent disability may also be provided in the form of a statement from the United States Veterans Administration.
If the placard owner is deceased, the personal representative or person who has possession of the placard must return the placard to the Department of Revenue. Failure to return the placard(s) is a misdemeanor.
Common questions about Form 2769
Is there a deadline?
The completed and signed Physician's Statement for Disabled License Plates or Placards (Form 1776) must be issued within 90 days of the application date.
Where do I file it?
Submit the items to your local license office. Mail to: Motor Vehicle Bureau P.O. Box 598 Jefferson City, MO 65105-0598. Phone: (573) 526-3669.
Are there fees?
A $2 fee for each temporary placard or $4 fee for each temporary replacement placard. (checked October 20, 2026) There is no fee for new, renewal, or replacement permanent placards.
Is there a penalty?
Fraudulent application, renewal, procurement, or use of a placard, or parking in a disabled parking space by a person not physically disabled or transporting a physically disabled person is a misdemeanor.
Where to get help with Form 2769
Visit dor.mo.gov/motorv/placards/ for additional information.
Sources
[1] Form 2769 (Revised 09-2026), Application for Disabled Person Placard, Missouri Department of Revenue (the Official source link on this page).