Disability Dmv Form Parking Details

This is an article about the Georgia Mv 9D form, which is a document that businesses in the state of Georgia use to report various types of taxable transactions. The information on this form can be used by the government to determine how much money it needs to collect in taxes, and businesses in Georgia are required to complete and submit this form every quarter. In addition, there are also specific instructions for completing this form that must be followed closely in order to ensure that the information is accurate and up-to-date.

In the listing, there's some good information relating to the georgia mv 9d form. Prior to fill out the form, it can be worth checking a little more about it.

QuestionAnswer
Form NameGeorgia Mv 9D Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameshow to ga disabled parking, disability dmv form parking, georgia disabled, georgia disabled parking permit

Form Preview Example

MV-9D (rev. 1-2013)

motor.etax.dor.ga.gov

Disabled Person’s Parking Affidavit

New

Renewal

Section One - Except for signature(s), this form must be typed, electronically completed and printed or legibly hand printed.

Note: The vehicle owner information is only required when applying for a DP license plate. You do not have to own a vehicle to obtain a DP parking permit (placard). Apply at the Tag Office in the county in Georgia where you reside.

* Vehicle Owner’s Full Legal Name

* Driver’s License # & Name of Issuing State (person operating vehicle)

*Vehicle Owner’s Street Address including city, state & zip

Disabled Person’s Full Legal Name

*County of Residence

*Relationship to Vehicle Owner- Check only one box

 

Child

Self

Spouse

Ward

* Disabled Person's Driver’s License # & Name of Issuing State(if applicable)

Disabled Person’s Street Address including City, State & ZIP

Active Military Duty Retired GA Veteran

Section Two - For Institutions Only: This vehicle is used primarily for the transportation of disabled persons.

Institution’s Full Legal Name (Institution as defined by Georgia Law §31-7-1)- Attach a copy of institutional license

Vehicle Year & Make

 

Vehicle Identification #

 

Vehicle Color

 

 

 

 

 

Institution Authorized Representative’s Signature & Position –‘PARKING PERMITS (Placards) ONLY’

Section Three

Vehicle Tag #

Date

Check applicable box(s) below: You may apply for both a Disabled Person’s Parking Permit and Disabled Person’s License Plate with this form.

Temporary Parking Permit (Placard) No Fee-Termination date of disability: ______________________________________

Permanent Parking Permit (Placard) No Fee- Must be replaced every four (4) years from issue date.

Special Permanent Parking Permit (Placard) No Fee-Because of a physical disability, drives a motor vehicle which has been equipped with hand controls for the operation of the vehicle’s brakes and accelerator; or is physically disabled due to the loss of, or loss of use of, both upper extremities. Must be replaced every four (4) years from issue date.

Disabled Person’s License Plate (Fee $20.00 plus any taxes that may be due).

Section Four - To be completed by a licensed doctor of medicine, osteopathic medicine, podiatrist, optometrist or a licensed chiropractor.

Is disability permanent?

Yes

No-Temporary permits shall be issued for no more than 180 days

I hereby swear and affirm that the above individual as defined by Georgia Law §24-9-101 and §460-6-221(5):

Is so ambulatory disabled that he/she cannot walk 200 feet without stopping to rest.

Cannot walk without use of assistance from a brace, a cane, a crutch, another person, a prosthetic device, a wheelchair, or other assistive device.

Is restricted by lung disease to such an extent that his/her forced respiratory volume for one second, when measured by spironmetry is less than one liter, or when at rest his/her arterial oxygen tension is less than 60 millimeters of mercury on room air.

Uses portable oxygen.

Has a cardiac condition to the extent that his/her functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

Is severely limited in his/her ability to walk due to an arthritic, neurological, orthopedic condition or complications due to pregnancy.

Is hearing impaired pursuant to Georgia Law §24-9-101.

Is blind individual whose central visual acuity does not exceed 20/200 in the better eye with correcting lenses or whose visual acuity. If better than 20/200, is accompanied by a limit to the field or vision in the better eye to such degree that is widest diameter subtends and angle of no greater than twenty-degrees(20).

Section Five - Certification

Licensed Doctor’s Printed Name

Doctor’s License #

State of Issuance

Signature

Office Street Address including City, State & ZIP

 

Telephone # including area code

Note: Notarization Required For Licensed Doctor’s Signature

 

 

Sworn to and subscribed before me

This ________ day of ______________________, ______

(Day)

(Month)

(Year)

Notary Public’s Signature & Notary Seal or Stamp

Date My Notary Commission Expires

County and State Use Only

*Retention Schedule: This form will be retained at the County Tag Office for two (2) years from the date issued. Disabled Person’s Parking Permit # ______________________________________

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