Mv 402 Form PDF Details

In the realm of vehicle regulations, certain forms stand out for their specialized purposes, such as the MV-402 form, a pivotal document for drivers in Pennsylvania seeking an exemption for sun screening on their vehicle's windows. Issued by the Commonwealth of Pennsylvania Department of Transportation, specifically through its Vehicle Inspection Division, this application facilitates legal authorization for vehicles to be equipped with aftermarket sun screening that otherwise wouldn't comply with standard regulations. Applicants are required to provide comprehensive details, including their full name, identification numbers, and contact information, alongside specific data about the vehicle in question, such as its make, model, VIN, and the windows intended for sun screening. Crucially, the form also delves into the history of the vehicle and the sun screening, including purchase and installation dates, to ensure that the modifications meet historical guidelines. Additionally, for those seeking a medical exemption due to conditions exacerbated by sunlight, the form accommodates this need with a section for a licensed physician or optometrist to detail the patient’s condition and validate the exemption request. Thus, the MV-402 serves a dual purpose—facilitating compliance with state vehicle regulations while also recognizing the unique needs of drivers requiring sun screening for health-related reasons.

QuestionAnswer
Form NameMv 402 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespenndot tint permit, pennsylvania tint exemption, tint permit, tint waiver pa

Form Preview Example

MV-402 (2-08)

Commonwealth of Pennsylvania

Department of Transportation

Vehicle Inspection Division

P.O. Box 68697

Harrisburg, PA 17106-8697

APPLICATION FOR SUN SCREENING CERTIFICATE OF EXEMPTION

FOR DEPARTMENT USE ONLY

THE FOLLOWING QUESTIONS ARE TO BE ANSWERED BY THE APPLICANT

1. Full Name

PA DL/Photo ID # or Bus. ID#

Date of Birth

Daytime Telephone #

NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID # in the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N).

2.

Street Address __________________________________________________________________________

 

City

 

 

State

 

Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Vehicle for which application is being made. Make

 

 

 

 

 

 

Year

 

VIN

 

 

 

 

Registration Plate

 

 

 

Title Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Windows with after market sun screening for which a certificate of exemption is requested:

“PLACE X WHERE NEEDED”

Windshield

 

 

 

Driver Side: Left Front ______________

Left Rear ______________

Passenger Side: Right Front _____________

Right Rear _____________

On vans, station wagons and buses list the number of additional rear side windows:

 

Number of additional passenger side right-rear windows: __________________

 

 

 

Number of additional driver side left-rear windows: _______________________

 

 

5.

When did you purchase this vehicle?

Date _______________/________/____________

 

 

Month

Day

Year

6.

When was the sun screening installed?

Date _______________/________/____________

 

NOTE: To be approved for window darkening

Month

Day

Year

 

products, installation must have been prior to

 

 

 

 

September 8, 1984.

 

 

 

6a.If unknown, was sun screening installed prior to

 

 

 

 

your ownership of the vehicle?

Yes _____________

No _______________

7. When was this vehicle first registered by you

 

 

 

 

in Pennsylvania?

Date _______________/________/____________

 

 

Month

Day

Year

8. What is the serial number of the current inspection

 

 

 

 

sticker displayed on this vehicle?

Number __________________________________

I certify under penalty of law that the above facts are true and correct to the best of my knowledge and that the vehicle is equipped with the after market sun screening as indicated.

Vehicle Owner’s Signature ________________________________________________ Date _______________

(When vehicle is registered in more than one name, all signatures must appear above.)

REQUEST FOR MEDICAL EXEMPTION

This portion must be completed by a licensed physician or optometrist when a certificate of exemption is requested due to a physical condition. NOTE: The exemption is valid only for colorless sun screening products that filter ultraviolet rays.

(Please type or print)

PATIENT INFORMATION

Patient Name ___________________________________________ Daytime Telephone # _________________

Street Address _____________________________________________________________________________

City ___________________________________________________ State __________ Zip Code ___________

Brief Description of patients condition: ___________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Suggested Treatment(s): _____________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

PHYSICIAN/OPTOMETRIST INFORMATION

Physician/Optometrist Name ___________________________________________________

Business Affiliation (if any) _____________________________________________________

Business Address ____________________________________________________________

City ___________________________________________ State _____ Zip Code _________

Physician Telephone Number __________________________________________________

I certify under penalty of law that the above facts are true and correct to the best of my knowledge:

Signature _______________________________________ Date _____________________

THE REVERSE SIDE MUST BE COMPLETED BY THE VEHICLE OWNER

How to Edit Mv 402 Form Online for Free

The how to get medical exemption for window tint filling in procedure is quick. Our editor allows you to work with any PDF form.

Step 1: Initially, choose the orange button "Get Form Now".

Step 2: Now you will be on the form edit page. You'll be able to add, change, highlight, check, cross, insert or delete areas or phrases.

The following sections are what you will need to fill in to obtain the finished PDF document.

completing pa window tint medical exemption form stage 1

The program will expect you to complete the Driver Side Left Front, Left Rear, Passenger Side Right Front, Right Rear, On vans station wagons and buses, Number of additional passenger, Number of additional driver side, When did you purchase this vehicle, Date, Month, Day, Year, When was the sun screening, Date, and NOTE To be approved for window field.

stage 2 to finishing pa window tint medical exemption form

You may be instructed to note the particulars to let the program fill in the field PATIENT INFORMATION, Patient Name Daytime Telephone, Street Address, City State Zip Code, Brief Description of patients, and Suggested Treatments.

Filling in pa window tint medical exemption form stage 3

The PHYSICIANOPTOMETRIST INFORMATION, PhysicianOptometrist Name, Business Affiliation if any, Business Address, City State Zip Code, Physician Telephone Number, I certify under penalty of law, and Signature Date section is where either side can describe their rights and obligations.

pa window tint medical exemption form PHYSICIANOPTOMETRIST INFORMATION, PhysicianOptometrist Name, Business Affiliation if any, Business Address, City  State  Zip Code, Physician Telephone Number, I certify under penalty of law, and Signature  Date blanks to insert

Step 3: Once you've selected the Done button, your document will be ready for export to any type of device or email you indicate.

Step 4: You can create duplicates of the document tokeep away from any possible future concerns. You need not worry, we cannot publish or monitor your details.

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