Form Mv 145 PDF Details

Understanding the MV-145 form is essential for individuals in Pennsylvania seeking a specialized vehicle registration plate due to a disability or hearing impairment. This form, officially titled "Application for Person with a Disability or Hearing Impaired Registration Plate or a Person with a Disability Motorcycle Plate," is a critical document processed by the Bureau of Motor Vehicles. The MV-145 form allows individuals, as verified by a health care provider, to apply for registration plates designated for persons with disabilities or those who are hearing impaired. With an application fee of $11, applicants can choose between a disability plate for either a standard vehicle or motorcycle, and for those who are hearing impaired, there’s a specific plate without parking privileges. Additionally, the form provides an option for obtaining two plates with identical numbers for vehicles equipped with a wheelchair or personal assistive device carrier. Detailed sections within the form guide applicants through providing vehicle information, owner details, and certification from a health care provider or police officer, depending on the nature of the disability. The option for personalized plates adds a personal touch but comes with additional fees and specific guidelines. The MV-145 form encapsulates a blend of regulatory compliance and personal accommodation, ensuring individuals with disabilities have the necessary support for their mobility needs while adhering to Pennsylvania's vehicle registration requirements.

QuestionAnswer
Form NameForm Mv 145
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespa disability plate, disability impaired plate, mv 145, pa mv plate

Form Preview Example

MV-145(3-15)

www.dmv.state.pa.us

APPLICATION FOR PERSON WITHADISABILITY OR HEARING IMPAIRED REGISTRATION PLATE ORA PERSON WITHADISABILITY MOTORCYCLE PLATE

For Department Use Only Bureau of Motor Vehicles • 1101 South Front Street • Harrisburg, PA 17104-2516

CHECK ( 4) APPROPRIATE BLOCKS BELOW - See reverse side for instructions and eligibility requirements.

qPerson with a Disability Plate (K9) - Complete Sections A, B, C or D (NOT BOTH), E (if applicable), and F. FEE: $11

qPerson with a Disability Motorcycle Plate (BK) - Complete Sections A, B, C or D (NOT BOTH), E (if applicable), and F. Fee: $11

qHearing Impaired Plate (S4) - Complete Sections A, B, C, E (if applicable), and F. FEE: $11(NOTE: No Special Parking Privileges)

Two Plates (with identical plate numbers) for vehicles equipped with a Wheelchair/Personal Assistive Device Carrier. (See reverse for instructions)

qFor two Person with a Disability Plates (IV) - Complete Sections A, B, C or D (NOT BOTH), E (if applicable), and F. FEE: $11

AVehicle Information (NOTE: In conjunction with replacement of your plate, you will receive one registration card. If additional registration cards are desired, the fee is $2 for each card. Number of Duplicate Registration Cards Requested @ $2 each ________.)

Title Number

Vehicle Identification Number

Registration Plate Number

 

 

 

B ApplicantInformation (List all information as shown on current registration card.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Owner Name (or Full Business Name)

PA DL/Photo ID#

 

 

Date of Birth

NOTE: If you are the parent or the adult charged by law with the natural parent’s rights, duties and

 

 

 

or Bus. ID#

 

 

 

responsibilities acting on behalf of a minor child (under 18) in place of the child’s natural parents

 

 

 

 

 

 

 

(person in loco-parentis), you must complete the information below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Co-Owner Name

 

PA DL/Photo ID#

 

 

Date of Birth

Name of Parent or Person in Loco Parentis

Relationship to Applicant

Applicant Age

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address

 

City

State Zip Code

Street Address

 

 

City

State

Zip Code

 

 

 

 

 

 

 

 

 

 

C

CertificationFromaHealthCareProviderLicensedorCertifiedinPAoraContiguousState(NewYork,NewJersey,Delaware,Maryland,WestVirginia

or Ohio). THIS SECTION MUST BE COMPLETED IN FULL.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is to certify that __________________________________ (Name of Person with Disability) is under my care and has a hearing impairment, or

 

has the following condition listed on the reverse side of this application under “Eligibility Requirements”: ____________ (List Reason Code #).

 

NOTE: If reason code #4 is listed above, please indicate the type of device used: _____________________________________.

 

 

 

 

NOTE: Only those conditions listed on the reverse side of this application qualify an applicant for a person with a disability plate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Health Care Provider’s Name

 

 

Health Care Provider’s Signature

 

 

 

 

Medical License No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Office Street Address

 

 

 

City

 

State

Zip Code

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

D

Certification by Police Officer - A police officer may only certify that the applicant does not have full use of a leg or both legs, or is blind.

NOTE: If Section C above is completed, please skip this Section.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

This is to certify that the person listed above with a disability has the condition checked below and is entitled to the use and privileges of the registration

 

plate requested,

qis blind, OR does not have full use of a leg or both legs as evident by the use of a:

 

 

 

 

 

 

 

 

qwheelchair

qwalker

qcrutches

 

 

qcane/quad cane

q other prescribed device

 

 

 

 

 

 

 

 

(state device)

 

Officer’s Name

 

 

 

 

Officer’s Signature

 

 

 

 

Badge Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department/Station

 

 

 

City

 

State

Zip Code

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E

OPTIONAL PERSONALIZATION REQUEST - (NOTE: Additional Fee Required. For appropriate fees see reverse side.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The number of allotted letters or numbers in combination varies depending on the selected registration plate type. Please see the reverse side of this application for additional instructions regarding the allotted spaces. Only one hyphen or space is permitted as one of the available spaces for personalization. No other special characters are available. Please print clearly.

 

 

 

FIRST CHOICE

 

 

 

SECOND CHOICE

 

 

THIRD CHOICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F

Notarization And Applicant Signature - Applicant, natural parent or other authorized person listed in Section B must sign below.

 

 

 

 

 

 

 

 

 

 

SUBSCRIBED AND SWORN

 

 

 

 

 

 

I state that I have read and signed this application after its completion, and I swear or

 

TO BEFORE ME:

 

 

MONTH

DAY

YEAR

 

 

 

affirm that the statements made herein are true and correct, and that any statement

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t

 

 

 

 

 

 

 

 

 

 

 

made on or pursuant to this application is subject to the penalties of 18 Pa.C.S.

 

SIGNATURE OF PERSON ADMINISTERING OATH

 

 

 

 

 

Section 4903(a)(2) (relating to false swearing), which shall include punishment of a

 

 

 

 

 

 

fine not exceeding $5,000, or to a term of imprisonment of not more than two years,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

or both.

 

 

 

 

 

 

 

S

T

A

M

P

SIGN IN PRESENCE OF NOTARY

 

 

 

 

(

)

 

 

 

 

 

Applicant Signature

Date

 

Telephone Number

 

 

 

 

(

)

 

 

 

 

 

 

Co-Applicant Signature

Date

 

Telephone Number

Plate Type

 

Eligibility Requirements

Qualifying Vehicles

 

 

Benefits

 

 

 

 

 

 

 

 

 

 

 

 

 

 

“Reason Codes”

(1) A passenger vehicle or truck with a

(1)

Parking

permitted

in

Person with a

Applicant:

registered gross weight of not more

spaces designated for disabled

Disability Plate

(1)

is blind.

than 14,000 lbs. The vehicle must be

persons and for 60 minutes in

 

 

(2)

does not have full use of an arm or both arms.

 

used by a person with disability or

excess of legal parking period

 

(3)

cannot walk 200 feet without stopping to rest.

operated exclusively for the use and

except where local ordinances

 

(4)

cannotwalkwithouttheuseof,orassistancefrom,

benefit of the person with a disability.

or police

regulations

provide

 

 

a brace, cane, crutch, another person, prosthetic

NOTE: Organizations that operate a

for

the

accommodation

of

 

 

device, wheelchair or other assistive device.

passenger vehicle to transport persons

heavy traffic

during

morning,

 

(5)

is restricted by lung disease to such an extent

with disabilities must supply PennDOT

afternoon or evening hours.

 

 

 

that the person’s forced (respiratory) expiratory

with the following:

(2) Upon request of a person

 

 

volume for one second, when measured by

a) A notarized statement of how

with

disability,

local authorities

 

 

spirometry, is less than one liter or the arterial

the vehicle will be used and the

may erect on the highway as

 

 

oxygen tension is less than 60 MM/HG on room

type of services that will be

close as possible to the person’s

 

 

air at rest.

provided.

residence

a sign(s) indicating

 

(6)

uses portable oxygen.

that the place is reserved for the

 

b) The weekly or monthly number

 

(7)

has a cardiac condition to the extent that the

personwithdisability,thatnoone

 

of hours that the services are

else

may

park there

unless

a

 

 

person’s functional limitations are classified in

 

 

provided.

person with disability

plate

or

 

 

severity as Class III or Class IV according to the

 

 

NOTE: The vehicle(s) must be titled in

placardisdisplayedandthatany

 

 

standards set by the American Heart

 

 

the name of the organization.

unauthorized

person

parking

 

 

Association.

 

 

 

there will be subject to a fine.

 

 

(8)

is severely limited in his or her ability to walk due

 

 

 

 

 

 

 

 

 

 

 

 

to an arthritic, neurological or orthopedic condition.

 

 

 

 

 

 

 

 

(9)

is a person in loco parentis of a person specified

 

 

 

 

 

 

 

 

 

in paragraph (1), (2), (3), (4), (5), (6), (7) or (8)

 

 

 

 

 

 

 

 

 

above.

 

 

 

 

 

 

 

Definition of Person in Loco Parentis - ANY ADULT charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a

 

 

 

minor child (under 18) in place of the child’s natural parents.

 

 

 

 

 

 

 

 

 

 

 

 

Hearing Inpaired

Any person with a hearing impairment verified by

No restrictions.

No special benefits.

 

 

Plate

a licensed health care provider.

 

 

 

 

 

 

 

 

 

 

 

 

Person with a Disability

Same disabilities as listed for Person with a

Motorcycle Only.

Same as above for Person

 

Motorcycle Plate

Disability Plate.

 

with a Disability Plate.

 

 

 

 

 

 

 

 

 

 

 

 

•A Health Care Provider is defined as a physician, chiropractor, podiatrist, physician’s assistant or a certified registered nurse practitioner. A Health Care Provider may only certify disabilities within their scope of practice.

•This application may only be used by a vehicle owner or co-owner that qualifies for the type of plate indicated on the front of this application unless the vehicle owner is a person in loco parentis of a qualified person. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).

•Only one plate issued per qualified person for one vehicle.

•Should you desire to renew your registration in conjunction with this application, you must complete Form MV-140, "Request for Registration," or your registration renewal application and return it with this application along with your annual registration fee and the $11 replacement registration plate fee (if applicable).

•Two registration plates (with identical plate numbers) may be issued for vehicles equipped with a wheelchair/personal assistive device carrier on the rear of the vehicle. One registration plate must be affixed to the rear of the vehicle and one registration plate must be affixed to the rear of the carrier attached to the vehicle for which the plates are issued.

•Send completed application to: Bureau of Motor Vehicles, 1101 S. Front Street, Harrisburg, PA 17104-2516.

IF PERSONALIZING YOUR REGISTRATION PLATE

•Personalized registration plates may contain:

-Person with a Disability registration plates - up to FIVE letters or numbers in combination. An additional $50 fee is required. NOTE: Pre-printed, stacked letter configurations will appear on your personalized registration plate.

-Person with a Disability Motorcycle registration plates - up to THREE letters or numbers in combination. An additional $50 fee is required. NOTE: Pre-printed, stacked letter configurations will appear on your personalized registration plate.

-Hearing Impaired registration plates - up to FIVE letters or numbers in combination. An additional $100 fee is required. NOTE: Pre-printed, stacked letter configuration will appear on your personalized registration plate.

-For two Person with a Disability wheelchair/personal assistive device carrier registration plates, up to FIVE letters or numbers in combination. An additional $50 fee is required. NOTE: Pre-printed, stacked letter configurations will appear on your personalized registration plate.

•If a hyphen or space is used as part of the registration configuration, it counts as one of the available spaces for personalization. Only one hyphen or space is permitted, but not both. NOTE: No additional special characters are available.

•When requesting a numeric character of zero, please list as "Ø" instead of the alpha character of "O".

•PennDOT reserves the right to limit or reject certain requests.

•The fee to personalize your Person with a Disability registration plates is an additional $50. The fee to personalize your Hearing Impaired registration plate is $100. The registration on your vehicle must be current in order for PennDOT to process your request. The additional fee covers the cost of your personalized registration plate order only and will not renew your vehicle's registration. If your registration has expired or expires in the next three months, please include your completed renewal application, Form MV-105, "Pennsylvania Registration RenewalApplication," or Form MV-140, “Request for Registration,” and a separate check or money order in the amount of your registration renewal fee. Payment is to be made by check or money order payable to the Commonwealth of Pennsylvania. PLEASE DO NOT SEND CASH.

•To check personalized registration plate availability, visit PennDOT’s Driver and Vehicle Services website, www.dmv.state.pa.us, and select the Personalized Registration Plate Availability link from the list of services under the Online Driver and Vehicle Services heading. Personalized registration plates will not be reserved until PennDOT receives payment and a completed application, and approves your requested registration plate configuration [number(s) and/or letter(s)]. Please note that registration plate requests are processed on a first-come, first-served basis. Although a requested registration plate configuration may show as being available on the website, it is possible that a request for the same registration plate configuration may have already been submitted by another customer and may not be available when making application.

•Personalized registration plates will be manufactured on the basis of this application. NO REFUND of the fee will be issued when an applicant cancels a request after the order is placed with the manufacturer.

•Allow eight to 10 weeks for delivery.

Visit us at www.dmv.state.pa.us or call us at:

In state: 1-800-932-4600 u TDD: 1-800-228-0676 u Out-of-State: 1-717-412-5300 u TDD Out-of-State: 1-717-412-5380

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disability impaired plate writing process outlined (stage 1)

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Office Street Address, Telephone Number, and State in disability impaired plate

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