Hsmv 83039 Form PDF Details

In Florida, there are specific laws and regulations that must be followed when registering a vehicle. The Hsmv 83039 form is one of the documents you will need to complete in order to successfully register your car. This form is used to provide information about the vehicle and its owner, such as the make, model, and VIN. Make sure you complete this form correctly and submit it with all other required documentation to the DMV. Failing to do so could result in delays or even denied registration. For more information about what is needed to register a vehicle in Florida, visit the DMV website.

Here's some facts that may help you determine the time it requires to finalize the hsmv 83039 form.

Form NameHsmv 83039 Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesflorida form for disabled parking permit, florida handicap parking permit application form, how to renew a florida handicap placard, hsmv 83039

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This form is not valid for more than 12 months from the date of the certifying authority’s signature.

Please Print/Type belowAPPLICATION BY DISABLED PERSON (See Warning Below)

I certify that I am a person with one of the disabilities listed in section 320.0848, Florida Statutes. I further state that my physician or other certifying practitioner has completed the statement of certification below on my behalf, as required in section 320.0848, Florida Statutes.

Name of Disabled Person as printed on their


Current Disabled Parking Permit Number


Signature of Disabled Person or Guardian of the Disabled

Florida Driver License or Florida ID Card


(if applicable)





Date of Birth



Disabled Person’s E-mail Address


Disabled Person’s Phone Number

Date Signed

















Florida Driver License or Florida ID Number:









If applicable, check one of the following:

(Required for permanent and temporary parking permits









I am a frequent traveler.


I am a quadriplegic.

unless exception is noted by physician below)










































TEMPORARY PERMIT: This is to certify that the applicant named above is a person with a temporary disability (six months or less) that limits or impairs his/her ability to walk or is temporarily sight impaired. Due to the temporary specific disability(ties) checked below (2-8), the disabled person parking permit should be issued from

(date) through



PERMANENT PERMIT: This is to certify that the applicant named above is legally blind or is a disabled person with a permanent disability (ties) that limits or impairs his/her ability to walk 200 feet without stopping to rest. Specify below (2-8) either legally blind or the specific disability (ties).


2. 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.

3.The need to permanently use a wheelchair.

4.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 person's arterial oxygen is less than 60 mm/hg on room air at rest.

5.Use of portable oxygen.

6.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.

7. Severe limitation in a person's ability to walk due to an arthritic, neurological, or orthopedic condition. 8. Legally Blind

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, F.S. The penalty is up to one year in jail or a fine of $1,000 or both.

Certification or License No. (Required)






of a Physician, Osteopathic or Podiatric Physician,




Chiropractor, Optometrist, Advanced Practice Registered Nurse under the protocol of a licensed physician or a Physician Assistant licensed




under Chapter 458 or 459.












Print/Type Name of Certifying Authority





Business Address






Certifying Authority Signature





Date Signed:




(Area Code)Telephone Number











SPECIAL EXCEPTION: The severely disabled applicant named above applying for a permanent placard is unable to obtain a Florida driver license or Identification card.



If the Special Exception box is checked, the certifying physician must provide his/her signature and date signed below.






If the Special Exception box is checked, one of the conditions in boxes 2-8 above must also be checked.







Certifying Authority Signature:








Date Signed:








provides regular transportation service to disabled persons having disabilities that limit or impair

This is to certify that















their ability to walk or are certified to be legally blind.























Number of Vehicles in fleet for this purpose:

Organization’s E-mail Address







Signature of Organization’s Authorized Representative










Date Signed:






























Agency Personnel Processing this Application














NOTE: For renewals and replacements only, a veteran who has been previously evaluated and certified by the United States Department of Veterans Affairs or any branch of the United States Armed Forces as permanently and totally disabled from a service-connected disability may provide a United States Department of Veterans Affairs Form Letter 27-333, or its equivalent, issued within the last 12 months in lieu of a certificate of disability.

HSMV 83039 - REV. 10/18


Osteopathic Physician. Podiatric Physician. Chiropractor. Optometrist.
Advanced Practice Registered Nurse licensed under Chapter 464, under the protocol of a licensed physician. Physician Assistant licensed to practice under Chapter 458 or Chapter 459.
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 with a signed statement verifying the physician's knowledge of Florida's eligibility guidelines (s. 320.0848(1)(b)2., 2, Florida Statutes).
The form HSMV 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”.
A Florida driver license number or Florida identification number is required unless the authorized physician certifies that the applicant’s disability is too severe to visit or be transported to an office to obtain a driver’s license or identification card.
Fees: There is no charge for a Permanent Parking Placard. A Temporary Parking Placard is $15.
Note: If a second Temporary Parking Placard is required within one year of the initial Temporary Parking Placard, there will be no charge. If a second Temporary Parking Placard is required outside the one year issuance, a fee of $15 would be required.
Section 316.1958, Florida Statutes, provides that motor vehicles displaying a license plate or parking permit issued to a disabled person by any other state or district subject to laws of the United States, shall be recognized as a valid plate or permit, allowing such vehicle the special parking privileges in Florida, provided such other state or district grants reciprocal recognition for disabled residents of this state. All of the United States has agreed to reciprocate.
Section 320.0848, Florida Statutes, provides for the issuance of the disabled person parking permit. The person must be currently certified as being legally blind or having a disability that renders him or her unable to walk 200 feet without stopping to rest. The disability must be due to a condition listed in (2‐8) on the reverse side of this form in the "Physician/Certifying Practitioner's Statement of Certification" section.
Section 320.0848(1)(d), Florida Statutes, provides that the department shall renew the disabled parking permit of any person certified as permanently disabled on the application if the person provides a certificate of disability issued within the last 12 months pursuant to this subsection.
Submit a copy of the registration for your expiring parking permit and a certificate of disability (form HSMV 83039). The form must be completed and signed by the certifying authority within the last 12 months. Send form by mail or in person to the tax collector office or license plate agency in the county where you live. For a temporary permit, submit the appropriate fees.
Please visit our online renewal site at www.GoRenew.com.

Proof of identity is required when submitting this application.

An additional permit may be issued to a disabled person who qualifies as a frequent traveler or as a quadriplegic.

An organization may be issued as many disabled person parking permits as it has vehicles (that are used to transport disabled persons).

Temporary parking permits are issued for the time period specified by the certifying authority, not to exceed six (6) months. Permits issued to disabled persons will expire in four years on the owner's birthday. Permits issued to an organization will expire in four years on June 30.

The permit must be hung on the rear view mirror of any vehicle used to transport the disabled person(s) while parked in a designated disabled person parking space. The permit number must be visible from the front of the vehicle.

It is unlawful for any person to obstruct the path of travel to an accessible parking space, curb cut or access aisle by standing or parking a vehicle within any such designated area.

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

HSMV 83039 - REV. 10/18


How to Edit Hsmv 83039 Form Online for Free

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Step 1: Choose the orange "Get Form Now" button on the webpage.

Step 2: The form editing page is presently open. You can include information or manage existing details.

Create the 83039 PDF and enter the content for every single area:

completing handicapped parking application stage 1

Jot down the details in the persons arterial oxygen is, Use of portable oxygen, Restriction by cardiac condition, American Heart Association, Severe limitation in a persons, Legally Blind, WARNING Any person who knowingly, misdemeanor of the first degree, Certification or License No, of a Physician Osteopathic or, LICENSED IN THE STATE OF, PrintType Name of Certifying, Business Address, City, and State.

Completing handicapped parking application part 2

Highlight the most important details of the Number of Vehicles in fleet for, Organizations Email Address, Signature of Organizations, Date Signed, Address, City, State, Zip, TAX COLLECTOR USE ONLY, Agency Personnel Processing this, Date, NOTE For renewals and replacements, HSMV REV, and wwwflhsmvgov field.

stage 3 to filling out handicapped parking application

Feel free to specify the rights and obligations of the parties within the Submit a copy of the registration, Please visit our online renewal, APPLICATION REQUIREMENTS, The form HSMV must be accurately, A Florida driver license number or, Fees There is no charge for a, Note If a second Temporary Parking, CERTIFYING AUTHORITIES, The PhysicianCertifying, and Physician licensed to practice paragraph.

Filling out handicapped parking application stage 4

End by reviewing the following sections and preparing them as required: Proof of identity is required when, Check your local phone book, and wwwflhsmvgov.

Entering details in handicapped parking application step 5

Step 3: Press the button "Done". The PDF form is available to be transferred. You can easily obtain it to your laptop or send it by email.

Step 4: Have at least two or three copies of the form to avoid all of the possible future troubles.

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