Form Mv2548 – Fill Out and Use This PDF

APPLICANT SECTION - Check appropriate boxes.

Original

Renewal of permanent card number(s): ______________

Replacement of card number(s): ______________

Please print clearly.

Legal Name of Person with Disability - First, Middle Initial, Last

Address

City, State, ZIP Code

Social Security Number (For Identification Purposes)	Month, Day, Year You Were Born	Female
		Male
Driver License/Nondriver ID Number - If none, write NONE	Telephone Number Where You May be Reached 7 a.m.-4 p.m.

I have read the information on this form and understand the qualifications under which my Disabled Parking ID Card may be issued.

		(Signature of Disabled Person) or	(Date)
		(Person Signing on Behalf of Disabled Person)
If signing on behalf of the person with a disability, give the following:
(Name of Person Signing for Applicant - Please Print)		(Relationship to Applicant)

ELIGIBILITY SECTION

This must be completed and signed by any of the following health care specialists licensed to practice in any state: a physician, an advanced practice nurse, a chiropractor, a physician assistant who is licensed or certified; or a Christian Science Practitioner residing in Wisconsin; or by an authorized VA representative. This statement is for issuance of a disabled parking ID card and is not to be

considered as a claim for VA benefits.

Does the applicant's medical condition or disability prevent them from exercising reasonable and ordinary control over a motor vehicle? If the answer is YES, the applicant will be required to complete knowledge, highway signs and road tests. Either answer will not prevent the issuance of the DIS ID card.

Yes

No

Name of Person Certifying Eligibility	Medical License Number
Address	Area Code - Office Telephone Number
City, State, ZIP Code
Eligibility Certification Statement	I certify that the applicant is permanently disabled
	according to the conditions specified on this form.

MV2548 2/2004(Authorized Signature of Health Care Specialist)(Date)

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Parking Identification Card Application for Individuals with a

PERMANENT DISABILITY

Wisconsin Department of Transportation

MV2548

Are you eligible?

Any person certified by an authorized health care specialist as having a PERMANENT disability is eligible for the Disabled Parking Identification Card. By legal definition, this includes any person who:

•Cannot walk 200 feet or more without stopping to rest;

•Cannot walk without the use of, or assistance from, another person or brace, cane, crutch, prosthetic device, wheelchair or other assistance device;

•Is restricted by lung disease to the extent that forced expiratory volume for 1 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;

•Uses portable oxygen;

•Has a cardiac condition to the extent that functional limitations are classified in severity as class III or IV, according to standards accepted by the American Heart Association;

•Is severely limited in the ability to walk due to an arthritic, neurological or orthopedic condition;

•Has an equal degree of disability to those described above.

ID CARD USE

A motor vehicle (except motorcycles and mopeds) displaying the Disabled Parking Identification (ID) Card issued by Wisconsin or any other state, is subject to all Wisconsin motor vehicle laws and is granted the following privileges when the person with the disability is entering/exiting the vehicle:

•Parking in places reserved for people with a disability;

•Exemption from time limitations in parking places with a half hour or more limit;

•Exemption from payment in metered parking places with half hour or more limit. This does not include payment collected by parking attendants.

•Upon request, a driver who is disabled may obtain fuel from a full-service pump at the same price as fuel from a self-service pump. This applies at locations where fuel is sold at retail from both full and self-service pumps. The retailer is not required to provide any other service that is not provided to customers who use a self-service pump.

INFORMATION

Individuals with a permanent disability are issued a blue disabled parking ID card that must be renewed every 4 years. NO FEE is required for issuance, renewal, or replacement, however, applications made at a local DMV Service Center which provides ID card service are subject to a $3 counter service fee.

If you are a licensed driver, the Department will review your disability relating to your ability to exercise ordinary and reasonable control over a motor vehicle. If the certifying health care specialist recommends a re-examination, you will be required to complete a knowledge, highway signs and road test to determine appropriate license restrictions.

The Department may cancel a disabled parking ID card which was issued as a result of fraud or error. Parking ID cards are valid in all 50 states and Puerto Rico.

UNAUTHORIZED ID CARD USE

Any person who lends the Disabled Parking ID Card to someone who is not authorized by law to use it, may be fined up to $200.00. In addition, the Department may cancel the Disabled Parking ID Card of any person who improperly uses it.

RELEASE OF NONEXEMPT INFORMATION

The Wisconsin Department of Transportation uses the information on this form to issue disabled parking identification cards. Under open records laws, the Department must make nonexempt information available upon request. If you want your name withheld from mailing lists of 10 or more individuals, check yes; otherwise, check no.

Yes. (Will remove your name from marketing lists.)

No.

AMERICANS WITH DISABILITIES ACT

The Wisconsin Department of Transportation complies with the Americans with Disabilities Act.

QUESTIONS

For questions about disabled parking ID cards:

Call: 608-266-3041

TTY: 608-264-8703

E-mail: special-plates.dmv@dot.state.wi.us

Write to the address given on page one.

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