Hsmv 83007 Form PDF Details

The HSMV 83007 form plays a crucial role in the lives of Florida residents who are experiencing disabilities that limit their mobility, offering a beacon of hope for easier access and mobility. Facilitated by the State of Florida Department of Highway Safety and Motor Vehicles Division of Motorist Services, this form is a gateway for eligible residents to obtain a Regular or Motorcycle International Wheelchair Symbol License Plate. Applicants must certify their residency in Florida, provide detailed information about their vehicle, and importantly, prove their eligibility through a physician's or certifying practitioner's statement. The form outlines specific disabilities that qualify an individual for the license plate, emphasizing the importance of assisting those with significant mobility impairments. Certification by recognized authorities is mandatory, ensuring the process maintains integrity and properly serves those in genuine need. With penalties in place for false statements, the state underscores the seriousness of the application. Tailored towards various vehicles including private automobiles, trucks under certain weight limits, and motorcycles, the form addresses both regular and specialized transportation needs. The HSMV 83007 form embodies Florida’s commitment to inclusivity and mobility for all its residents, ensuring those with severe mobility impairments can lead more accessible, dignified lives.

QuestionAnswer
Form NameHsmv 83007 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesform83007, form hsmv 83007, florida dmv form 83007, 83007 form

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STATE OF FLORIDA

DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES

DIVISION OF MOTORIST SERVICES

SUBMIT THIS FORM TO YOUR LOCAL TAX COLLECTOR OFFICE

www.flhsmv.gov/offices/

APPLICATION FOR REGULAR AND MOTORCYCLE

INTERNATIONAL WHEELCHAIR SYMBOL LICENSE PLATE

I, ___________________________________________________________, certify that I am a legal resident of Florida residing at

Street Address

City

State

Zip

and I am the registered Owner Lessee of the following described motor vehicle:

Vehicle Identification Number

 

Year

Make

Color

Body

Florida Title Number

Owner/Lessee Date of Birth

Sex

Current License Plate Number

 

Owner/Lessee E-Mail Address

Florida Driver License or Identification Number: ________________________________________________________________________

I certify that I qualify for the wheelchair symbol license plate as defined in sections 320.0843 or 320.0848, Florida Statutes, and I have obtained the appropriate physician/certifying practitioner’s certification.

Check one:

Regular size license plate

Motorcycle size license plate

______________________________________________________________________

________________________________________

SIGNATURE – DISABLED PERSON

Date

PHYSICIAN/CERTIFYING PRACTITIONER’S STATEMENT OF CERTIFICATION

For Disabled Person to Obtain a Regular or Motorcycle Size Wheelchair Symbol License Plate

This is to certify that ____________________________________________________________ is legally blind or is a disabled person with a specific

disability (ies) that limits or impairs his/her ability to walk 200 feet without stopping to rest. The specific disability (ies) is/are checked below: Legally blind (This is the only disability an Optometrist can certify)

* * * NOTE: "Unable to walk 200 feet" is no longer a qualifying disability, unless it is due to one of the conditions listed below (a-f). * * *

a.Inability to walk without the use of or assistance from a brace, cane, crutch, prosthetic device, or other assistive device, or without assistance of another person. If the assistive device significantly restores the person’s ability to walk to the extent that the person can walk without severe limitation, the person is not eligible for the exemption parking permit or the wheelchair symbol license plate.

b. The need to permanently use a wheelchair.

C. Restriction by lung disease to the extent that the person’s forced (respiratory) expiratory volume for 1 second, when measured by spirometry, is less than one liter or the persons arterial oxygen is less than 60 mm/hg on room air at rest.

d. Use of portable oxygen

e.Restriction by cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

f. Severe limitation in a person’s ability to walk due to an arthritic, neurological, or orthopedic condition.

Print/Type Name of Certifying Authority

Signature

Date Signed

 

 

 

Business Street Address

 

(Area Code) Telephone Number

 

 

 

 

City

State

Zip Code

 

Certification or License No. (Required)

of Physician, Osteopathic or Podiatric Physician, Chiropractor, Optometrist,

Advanced Registered Nurse Practitioner under the protocol of a licensed physician or a Physician Assistant licensed under Chapter 458 or 459. LICENSED IN THE STATE OF: _______________________________

WARNING: Any person who knowingly makes a false or misleading statement in an application or certification under section 320.0848, Florida Statutes, commits a misdemeanor of the first degree, punishable as provided in section 775.082 or 775.083, Florida Statutes. The penalty is up to one year in jail or a fine of $1,000 or both.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 83007 (Rev. 10/11) S

www.flhsmv.gov

PROCEDURES AND INSTRUCTIONS

WHEELCHAIR SYMBOL LICENSE PLATE MAY BE USED ON THE FOLLOWING TYPE VEHICLES:

1.Automobiles for private use or lease.

2.Trucks weighing 5,000 pounds or less or heavy trucks with a GVW less than 8,000 pounds.

3.Automobiles, which seat under nine passengers and are for hire.

4.Motor homes or truck campers.

PROVISIONS OF LAW:

Section 320.0843, Florida Statutes, provides for the issuance of a wheelchair symbol license plate to any owner or lessee of a motor vehicle who qualifies for a disabled person parking permit under section 320.0848, Florida Statutes.

APPLICATION REQUIREMENTS:

1.The form HSMV 83007 or 83039 must be accurately completed, including the "Physician/Certifying Practitioner's Statement of Certification" section verifying the disability. See list below for acceptable "certifying authorities."

2.A copy of the vehicle registration certificate.

3.Proof of insurance indicating personal injury protection and property damage liability coverage.

4.Contact your Local County Tax Collector's office or License Plate Agency for fee information.

MOTORCYCLE WHEELCHAIR SYMBOL LICENSE PLATE MAY BE USED ON THE FOLLOWING TYPE VEHICLES:

1.Motorcycles for private use or lease.

2.Mopeds for private use or lease.

3.Motorized bicycles for private use or lease.

4.Motorized disability access vehicles for private use or lease.

PROVISIONS OF LAW:

Section 320.08035, Florida Statutes, provides for the issuance of a wheelchair symbol license plate on a motorcycle when the applicant meets the requirements defined in Section 320.0848, Florida Statutes.

APPLICATION REQUIREMENTS:

1.The form HSMV 83007 or 83039 must be accurately completed, including the "Physician/Certifying Practitioner's Statement of Certification" section verifying the disability. See list below for acceptable "certifying authorities."

2.A copy of the vehicle registration certificate.

3.Contact your Local County Tax Collector's office or License Plate Agency for fee information.

CERTIFYING AUTHORITIES:

The "Physician/Certifying Practitioner's Statement of Certification" section on the reverse side of this form MUST be completed by one of the following and must include the certifying authority's license number and the name of the state where their license was issued:

Physician licensed to practice under Chapters 458, 459 or 460, Florida Statutes, or similarly licensed by another state. NOTE: Documentation of the physician's licensure in the other state must be submitted.

 Osteopathic Physician.

Podiatric Physician.

Chiropractor.

Optometrist (for sight only).

Physician who practices medicine in a military medical facility, state hospital or federal prison. Indicate the facility and the address.

Advanced registered nurse practitioner licensed under Chapter 464, under the protocol of a licensed physician.

Physician assistant licensed to practice under Chapter 458 or Chapter 459.

A LICENSE PLATE WILL BE ISSUED AND MUST BE RENEWED ANNUALLY.

Check your local phone book government pages or visit the following website for current mailing addresses: http://www.flhsmv.gov/offices/

HSMV 83007 (Rev. 10/11) S

www.flhsmv.gov

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2. When the previous array of fields is done, you're ready to include the needed specifics in NOTE Unable to walk feet is no, a Inability to walk without the, b The need to permanently use a, spirometry is less than one liter, d Use of portable oxygen e, according to standards set by the, f Severe limitation in a persons, PrintType Name of Certifying, Area Code Telephone Number, Date Signed, of Physician Osteopathic or, Signature, Zip Code, State, and WARNING Any person who knowingly so you're able to proceed further.

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