Form DPSSP 1060 at a glance
What it is: DPSSP 1060 is the State of Louisiana Window Tint Medical Exemption Affidavit.
Who signs: You certify and attest under penalty of law that the information provided herein is true and accurate.
A filled-in Form DPSSP 1060 example: an owner with a PO Box mailing address
How to fill out Form DPSSP 1060, box by box
Parish, full name, driver's license number, date of birth and phone number
Enter the parish in the blank after State of Louisiana Parish of.
Enter the Full Name (Last, First Middle) and the Driver's License Number.
Enter the Date of Birth (MM/DD/YYYY) and the Phone Number.
Physical address and mailing address
Under Physical Address, enter the Street Address, City, State and Zip.
Under Mailing Address, enter the PO Box, City, State and Zip.
If your mailing address is the same as your physical address, check the box My mailing address is the same as my physical address.
Vehicle information and the registered owner
Under Vehicle Information, enter the Year, Make, Model, Vehicle Identification No. and License Plate of the Louisiana registered vehicle. The affiant declares that he/she is the registered owner or the spouse or immediate family member having significant use of that vehicle. The affiant states that, pursuant to L.R.S. 32:361.2, valid medical reasons (indicated on page 2) exist which make it necessary to equip the vehicle with sun-screening material which would be of a light transmission or luminous reflectance in violation of L.R.S. 32:361.1.
The affiant's declarations, certification, signature and date
The affiant 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.
By signing on page 1, you authorize the Louisiana State Police to release all pertinent criminal record information maintained in their files, other states files, or the FBI files (if applicable) which may confirm or deny your eligibility with the facility or agency named above. Pursuant to Title 28, C.F.R., Section 16.34, officials making the determination of suitability for licensing or employment shall provide the opportunity to complete, or challenge the accuracy of, the information contained in the FBI identification record.
The 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. 32:361.2.
You certify and attest under penalty of law that the information provided herein is true and accurate.
Sign on the Signature of Affiant line and enter the Date.
Notary public and Louisiana State Police
The form has a Notary Public line and a Seal / Notary Number line after the Signature of Affiant and Date.
For optometrist or physician's use only: the patient
For optometrist or physician's use only: Patient's Full Name, Patient's DOB.
Enter the Patient's Full Name and the Patient's DOB.
Recognized condition and Describe (All other)
Indicate the World Health Organization International Classification of Disease ICD9-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 (All other).
Photophobia explanation
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. 32:361.2 will not affect the individual's ability to drive at night.
Physician name, signature, date and phone number
Print the Physician Name and enter the Physician Signature, the Date and the Phone Number with Area Code.
More rules for Form DPSSP 1060
Louisiana State Police may seek the Medical Advisory Board's opinion whether to grant the medical exemption.
Age, the certificate and tint limits
The owner is age 60 years or older
The exemption will be valid for the duration of ownership of a vehicle whose owner is age 60 years or older.
The exemption is issued
The 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.
Tint is placed on the windshield or on the side and rear windows
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.
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 25% for the front side windows, 25% for the rear side windows and 12% for the rear windshield.
Common questions about Form DPSSP 1060
What medical condition do I need for tint?
The form lists Albinism, Lupus (Lupus Family) and Porphyria as boxes to check, and a Describe (All other) section, and for Photophobia an explanation as to the exemption under L.R.S. 32:361.2.
Sources
[1] Form DPSSP 1060, Window Tint Medical Exemption Affidavit, Louisiana State Police (the Official source link on this page).