Kentucky Form Tc 96 204 PDF Details

It’s tax season and having a thorough understanding of the various forms you are required to complete is key. If you’re a resident of Kentucky, the TC 96-204 form might be one that needs your attention. In this blog post, we will provide an overview of what this form entails, its purpose, and any important deadlines or tips associated with filing your taxes accurately in line with KY state regulations. Whether you are already familiar with TC 96-204 or simply looking for more information on how it applies to you—this post has it all! So put on your favorite cup of coffee (or tea) and buckle up—it’s time to dive deep into everything Kentucky Form TC 96 204!

QuestionAnswer
Form NameKentucky Form Tc 96 204
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesky form t v 96 204, tc form, medical examination form kentucky, form tc 96 204

Form Preview Example

Kentucky Transportation Cabinet

TC 96-204

Division of Motor Vehicle Licensing

July 2011

 

APPLICATION FOR DISABLED PERSON’S SPECIAL

 

PARKING PERMIT

 

(Complete and forward to your County Clerk.)

 

SECTION 1 – TO BE COMPLETED BY APPLICANT

Name: _____________________________________________________________________________ Phone: ________________________

Address: _______________________________________________________________________________________________________________

(Street or Post Office)(City)(State)(Zip Code)

VIN of the vehicle owned or leased by a person with a disability __________________________________________

CHECK ONE:

License Plate or Placard

 

Applicant now holds disabled parking license/placard No. HP _______________________________

 

Applicant now holds disabled veteran license/placard No. HV _______________________________

 

County Clerk attests that applicant is obviously disabled in Section 2 below.

 

A licensed physician signs statement that applicant is disabled in Section 3 below.

__________________________________________________________

__________________________________________________________

(Signature of Applicant)

(Social Security)

Subscribed and sworn to before me this __________ day of _________________________________ 20 __________

My commission expires _________________________, 20 _________

________________________________________________

 

(Signature of Person Attesting Oath)

SECTION 2 – TO BE COMPLETED BY COUNTY CLERK

I hereby attest that the applicant is obviously disabled in compliance with KRS 186.042, and should be issued a special parking permit.

Signature of Clerk __________________________________________________________

County ________________________________

Section 3 need not be completed when Section 2 is completed.

SECTION 3 – TO BE COMPLETED BY A LICENSED PHYSICIAN OR ADVANCED PRACTICE

REGISTERED NURSE

I certify that the applicant is a person with disabilities which limit or impair the ability to walk 200 feet without stopping; without the use of assistant device; without portable oxygen; due to arthritic, neurological, or orthopedic condition; restricted by lung disease; or has a cardiac condition in compliance with KRS 186.042.

CHECK ONE: This is a

Permanent Disability

Temporary Disability

Signature of Licensed Physician/APRN _________________________________________________________________________________

Printed Name of Physician/APRN ______________________________________________ License # ______________________________

COUNTY CLERK’S USE ONLY

Previous Placard # __________________________________________________

Expires _____________________________________

New Placard # ______________________________________________________

Expires _____________________________________

Replacement Reason: __________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

County Clerk File Copy

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To be able to complete this form, make sure that you type in the right information in each area:

1. It's vital to fill out the tc form properly, hence be careful while working with the segments containing these fields:

Ways to complete tc 96 204 ky form stage 1

2. Given that this part is done, you need to put in the required specifics in I hereby attest that the applicant, County, Section need not be completed, SECTION TO BE COMPLETED BY A, I certify that the applicant is a, REGISTERED NURSE, CHECK ONE This is a, cid Permanent Disability cid, Signature of Licensed, COUNTY CLERKS USE ONLY, Previous Placard New Placard, Expires, and Expires so you can go to the 3rd step.

Stage no. 2 for filling out tc 96 204 ky form

As for I certify that the applicant is a and cid Permanent Disability cid, be sure that you take a second look in this current part. Both of these are the most significant fields in this file.

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