Georgia Mv 9D Form – Fill Out and Use

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.

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

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.

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

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 # ______________________________________