Form Rg 007A – Fill Out and Use This PDF

Section 1 – Check type of transaction

Veteran Wheelchair (HV) (Must also meet requirements for Veteran who has a disability; No fee – Permanent Plate) PLACARD - $1.00 Limit 1 per applicant. Applicant must have a SCDL, BP or ID photo on file with SCDMV.

DECAL (For display on Purple Heart motorcycle, Veteran who has a disability motorcycle, and World War II plates only)

Applications are accepted at SCDMV branches or can be mailed along with a check or money order (no cash accepted) payable to the SCDMV:

SC Department of Motor Vehicles, PO Box 1498, Blythewood, SC 29016-0019

Warning: A person who duplicates, forges, or sells a placard or a person who falsifies information on an application form for a placard or plate is guilty of a misdemeanor and, upon conviction, must be imprisoned for 30 days and fined not less than $500 and not more than $1,000. Placard will be mailed to applicant.

Section 2 –Person’s Information – Required for Placard or Plate (** indicates optional information)

I certify that this information is true and correct.

INSURANCE CERTIFICATION

Under penalties of perjury, I declare this vehicle is insured with ________________________________________ and I will maintain liability insurance throughout the registration

Section 4 – Physician’s Statement

A licensed Physician, an Advanced Practice Registered Nurse (APRN), or a Physician Assistant (PA) must complete this portion of the application and must indicate the disability and length of disability. APRNs are nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists.

APPLICANTS WHO HAVE A DISABILITY MUST BE CERTIFIED BY A LICENSED PHYSICIAN, AN APRN, or PA.

an inability to ordinarily walk one hundred feet nonstop without aggravating an existing medical condition, including the increase of pain;

an inability to ordinarily walk without the use of, or assistance from a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device;

a restriction by lung disease to the extent that the person's forced 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 at rest;

requires use of portable oxygen;

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 established by the American Heart Association. If the person's status improves to a higher level, for example as a result of bypass surgery or transplantation, he no longer meets this criteria;

a substantial limitation in the ability to walk due to an arthritic, neurological, or orthopedic condition, for example, coordination problems and muscle spasticity due to conditions that include Parkinson's disease, cerebral palsy, or multiple sclerosis; or

Instructions for completing the Application for Placard and/or License Plate for

People Who Have a Disability (RG-007A and RG-007B)

LICENSE PLATES

Individual

Plates are available to people, or their immediate family members, who a licensed Physician, Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA) have certified as having a permanent disability for vehicles registered to the person who has a disability or an immediate family member with the same address. APRNs are nurse practitioners, certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists. A registration certificate, which lists the name of the person who has a disability, will be issued with each plate and must be maintained in the applicable vehicle. The plate fee is $36.00.

Business/Organization

Businesses or organizations that, as a part of their business, routinely transport people who have a disability may be issued plates for vehicles of special design, equipped to transport certified people who have a disability, and registered in the name of the business organization. To obtain plates for an institution, a representative for the institution should complete the application for an Organization Placard and License Plate for People Who Have a Disability (SCDMV Form RG-007B). A Physician or an ARPN’s certification is not required.

PLACARDS

Individual

Placards are available to people who a licensed Physician, an ARPN, or a PA have certified as having a disability. To apply, you must have a current driver’s license, beginner’s permit, or identification card photo on file with the SCDMV. If a photo is not on file, you must apply for one before a placard can be issued. A registration certificate will be issued with each placard and must remain with the person who has a disability when the placard is used. The placard fee is $1.00 and only one placard may be issued per applicant.

Business/Organization

Permanent placards may be issued to organizations that transport people who have a disability. Only one placard may be issued for each vehicle registered in the name of the organization. The organization must submit a completed Organization Placard and License Plate for People who have a Disability (SCDMV Form RG-007B). The fee is $1.00 per placard and is limited to the number of registered vehicles.

RG-007A Application for Placard and/or License Plate for People Who Have a Disability (Individual)

Complete a separate application form for each person who has a disability.

Section 1 - Check type of transaction

All applicants must complete this section.

plates.

Section 2 –Person who has a disability information (Required for ALL applicants.)

Provide the full legal name, street and mailing address, including city, state and zip code, and the phone number of the person who has a disability. List the SC driver’s license, beginner’s permit, or identification card number of the person who has a disability. Signature of person who has a disability or legal guardian required.

Section 3 – Vehicle Information (Required if requesting plate only.)

Complete this section only if you are applying for a license plate. License plates may be issued to vehicles used to transport a certified person who has a disability if the vehicle is owned and titled in the name of the person who has a disability or his/her immediate family member, who resides in the same household. The fee is $20.00 every two years. Indicate Gross Vehicle Weight (GVW) for property carrying vehicles.

Indicate if you wish to donate to Donate Life SC. If you would like to make a donation, indicate the amount in the space provided. For more information on Donate Life SC, visit www.donatelifesc.org.

The vehicle owner must sign to certify that the vehicle is insured and will maintain insurance throughout the registration period. The name of the liability insurance company should be listed, not the agent.

Section 4 –Medical Statement

A licensed Physician, an ARPN, or a PA must complete this portion of the application. The Physician must certify the applicant as having a disability by checking the qualifying conditions. The Physician, ARPN or PA must also indicate if the disability is permanent or temporary (impairment must be for at least 4 months not to exceed 1 year) and state the length of the disability in the space provided.

RG-007B Business/Organization Placard and/or License Plate for People Who Have a Disability

Section 1 - Check type of transaction

Business/Organization must complete this section.

Placard – Applying for a permanent placard

Section 2 – Business/Organization’s Information (Required for ALL applicants.)

Provide the business/organization’s name, street and mailing address, including city, state and zip code and phone number. The vehicle owner must sign to certify that the vehicle is insured and will maintain insurance throughout the registration period. The name of the liability insurance company should be listed, not the agent.

Section 3 – Vehicle Information - Required if requesting plate only.

List all registered vehicles for which the organization is buying license plates. Plates will be issued to vehicles used to transport a certified person who has a disability if the vehicle is owned and titled in the name of the business/organization. The fee is $36.00 every two (2) years. Indicate if you wish to donate to Donate Life SC. If you would like to make a donation, indicate the amount in the space provided. For more information on Donate Life SC, visit www.donatelifesc.org.

Applications are accepted at an SCDMV branch or can be mailed to the following address along with a check or money order (no cash accepted) payable to the

SCDMV:

SC Department of Motor Vehicles

P. O. Box 1498

Blythewood, SC 29016-0019