Louisiana Window Tint Exemption Sticker Form PDF Details

In Louisiana, navigating the rules regarding window tint can be complex, especially when medical conditions necessitate deviations from standard regulations. To accommodate individuals with specific health-related needs, the state has introduced the Louisiana Window Tint Medical Exemption Affidavit. This crucial document allows for the application of sun-screening materials on vehicle windows that would otherwise violate the state's stringent window tint laws, outlined in L.R.S. 32:361.1 and L.R.S. 32:361.2. The form requires detailed personal information, vehicle identification, and a statement from a physician or optometrist, justifying the medical necessity for the exemption based on recognized conditions such as albinism, lupus, and porphyria, among others. Moreover, the affidavit includes provisions for older vehicle owners, offering extended or potentially indefinite validity under certain conditions. This document, thoroughly vetted by the Louisiana State Police and possibly the Medical Advisory Board, embodies a careful balance between upholding public safety standards and accommodating individual health concerns. With legal limits for window tint set at specific light transmission percentages for different vehicle windows, this exemption represents a critical lifeline for those with qualifying conditions, making it essential for affected Louisiana residents to understand the affidavit's intricacies and requirements.

QuestionAnswer
Form NameLouisiana Window Tint Exemption Sticker Form
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other nameslouisiana window tint security exemption, louisiana form window tint, louisiana tint exemption form, how to get a tint exemption in louisiana

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State of Louisiana

Parish of ___________________________

WINDOW TINT MEDICAL EXEMPTION AFFIDAVIT

Tint may be placed on the windshield being affixed to the topmost portion of the

windshield not to extend more than six inches down from the top.

FULL NAMEDRIVER’S LICENSE NUMBERDATE OF BIRTH

_____________________________________________________________

ADDRESS

CITY

 

STATE

ZIP

(AREACODE) PHONE NUMBER

 

 

 

 

 

YEAR

MAKE

MODEL

VEHICLE IDENTIFICATON NO.

LICENSE PLATE

___________________________________________________________________________

Vehicle Information

Affiant declares that he/she is the registered owner or the spouse or immediate family member having significant use of the above- described Louisiana registered vehicle. Affiant states that, pursuant to L.R.S. 32:361.2, valid medical reasons (indicated below) exist which makes it necessary to equip the above described vehicle with sun-screening material which would be of a light transmission or luminous reflectance in violation of L.R.S. 32:361.1.

Affiant further declares that he/she has not been convicted of any drug offense or any violent crime and authorizes the Department to perform a criminal history inquiry.

Further, Affiant authorizes the Louisiana State Police access to all medical records related to the medical condition which may qualify as an exemption under L.R.S. 32:361.1 as defined L.R.S. 361.2.

Exemption will be valid for the duration of ownership of a vehicle whose owner is age 60 years or older.

I certify and attest under penalty of law, the information provided herein is true and accurate.

__________________________________

_________________

SIGNATURE OF AFFIANT

 

 

DATE

___________________________________

 

 

NOTARY PUBLIC

 

 

 

___________________________________

________________

SEAL / NOTARY NUMBER

 

LSP Certificate Number

 

NOT VALID UNLESS AUTHORIZED BY LOUISIANA STATE POLICE

Approved & Authorized

Disapproved

 

________________________________

_________

________

TESS-MVI

For the Deputy Secretary, Public Safety Services

Data Number

Date

Section

 

 

 

 

DPSSP 1060 (REV 8/09)

 

 

PAGE 1 of 3

(Legal window tint is 40% light transmission.)

NOTE: L.R.S. 32:361.1 provides that the legal limits to the sun screening device (window tint) on a passenger car are light transmissions of 40% for the front side windows, 25% for the rear side windows and 12% for the rear windshield.

WINDOW TINT MEDICAL EXEMPTION

THIS MEDICAL EXEMPTION IS NON-TRANSFERABLE AND EXPIRES THREE (3) YEARS FROM DATE OF ISSUANCE. THE ORIGINAL CERTIFICATE MUST BE CARRIED IN THE VEHICLE AT ALL TIMES AND SHALL BE VOID IF ALTERED OR FALSIFIED.

BELOW THIS LINE FOR OPTOMETRIST OR PHYSICIAN’S USE ONLY

Patient’s Full Name ___________________________

Patient’s DOB ____________________

Indicate the below listed World Health Organization International Classification of Disease ICD- 9-CM recognized condition which would require a medical exemption under L.R.S. 32:361.2. Provide a complete and detailed description under the section indicated as “DESCRIBE”. Louisiana State Police may seek the Medical Advisory Board’s opinion whether to grant the medical exemption.

Albinoism Lupus (Lupus Family) Porphyria

Describe (All other)________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Photophobia as a medical condition requires an explanation as to the exemption under L.R.S. 32:361.2. Indicate in detail why a correct pair of sunglasses would not be adequate protection thus requiring the exemption under L.R.S. 32:361.2, and why this exemption under L.R.S.361.2 will not affect the individual’s ability to drive at night.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Print Physician Name

Physician Signature

Date

(Area Code) Phone Number

DPSSP 1060 (REV 8/09)

 

 

PAGE 2 of 3

WINDOW TINT MEDICAL EXEMPTION

Official Use Only of the Medical Advisory Board

Date_____________________ Approved ____________________ Denied___________________

Reason for Approval or Denial

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

_________________________________

________

Advisory Board Physicians Signature

Date

LAC 55:813(T) The Medical Exemption Affidavit shall:

i. be valid for a period of not more than 3 years, except for the following provisions;

(a). The registered owner of the vehicle is 60 years and older at the time of application for a Medical Exemption Affidavit, or the individual becomes 60 years old while in possession of a valid Medical Exemption Affidavit, then the affidavit will be valid for the duration of that individual’s ownership of the vehicle as provided in LRS 32:361.2(A)(3)(c) unless deemed otherwise by the Department.

(b). The applicant for the Medical Exemption Affidavit is 60 years and older at the time of application for a Medical Exemption Affidavit, or the individual becomes 60 years old while in possession of a valid Medical Exemption Affidavit, but is not the registered owner of the vehicle, in which case the Department shall review the case as provided in LRS 32:361.2(A)(3)(b) and LRS 32:361.2(A)(3)(c).

DPSSP 1060 (REV 8/09)

PAGE 3 of 3

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2. Now that the previous segment is complete, you're ready insert the necessary specifics in I certify and attest under penalty, DATE, NOTARY PUBLIC, SEAL NOTARY NUMBER, LSP Certificate Number, NOT VALID UNLESS AUTHORIZED BY, Approved Authorized Disapproved, DPSSP REV, and PAGE of in order to go to the 3rd stage.

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Describe All other, PAGE  of, and Describe All other of louisiana state police tint exemption

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