Kentucky Form Tc 96 204 PDF Details

Securing a Disabled Person’s Special Parking Permit in Kentucky requires navigating through the specific details and mandates set forth by the Kentucky Transportation Cabinet via the TC 96-204 form, a critical document revised in July 2011 that streamlines the process for individuals seeking this essential accommodation. This form serves as an application that must be completed and forwarded to the county clerk, comprising various sections designed to capture comprehensive information about the applicant. These sections require personal details, a description of the disability, the vehicle identification number (VIN) of the vehicle owned or leased by the person with a disability, and specifying the type of parking permit needed—whether a license plate or placard. Importantly, the form accommodates either a statement from the county clerk attesting to the applicant's visible disability or a medical certification from a licensed physician or advanced practice registered nurse, confirming the nature of the disability. Specifically, the medical certification must attest that the applicant’s disability limits or impairs the ability to walk 200 feet without stopping due to various conditions. This meticulous process highlights the state's commitment to ensuring that special parking permits are issued to those genuinely in need, balancing the need for thorough verification with the applicant's convenience.

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

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

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