Form MV-80W at a glance
What it is: This application is for a tinted window exemption.
A filled-in Form MV-80W example: a registrant asks for her own exemption
How to fill out Form MV-80W, box by box
Tap a group of boxes to open it, and a picture to see it full size.
Vehicle registration information
Provide the following information as it appears on the vehicle registration, as well as the driver license ID number: write the Last Name, First, M.I., Driver License ID #, Address (Number and Street), Apt. #, City, State, Zip Code and Phone Number.
Someone other than the registered owner of the vehicle
If a medical exemption is requested for someone other than the registered owner of the vehicle, provide the following information about that person: write the Last Name, First, M.I., Driver License ID #, Address (Number and Street), Apt. #, City, State, Zip Code, Phone Number, Nature of Relationship to Applicant, and Frequency of and Reason for Such Person's Ridership in Applicant's Vehicle.
Signature of Vehicle Registrant
I certify and affirm that all information presented in this form is true and correct, that any documents, including supporting documentation, that I have presented to DMV are true, accurate and genuine. I make this certification and affirmation under penalty of law, and false statements made herein are punishable as a class A misdemeanor pursuant to section 210.45 of the Penal Law.
Sign on the Signature of Vehicle Registrant line and write the Date, signing name in full.
Patient's date of birth and examination date
This side must be completed by a NYS-licensed physician/physician assistant/nurse practitioner, who writes the Patient's Last Name, First Name, M.I., the Date of Birth (Month/Day/Year) and the Examination Date (which must be within 60 days of the date this form is submitted to DMV).
Medical condition
The medical condition checked must justify granting an exemption for the above-named patient from the limits on light transmittance found in Vehicle and Traffic Law, and personal protective measures such as sun-protective clothing, sunscreen, eye-protective devices or clear UV-protective window films do not offer adequate protection.
Check the condition: albinism, chronic actinic dermatitis/actinic reticuloid, dermatomyositis, lupus erythematosus, porphyria, xeroderma (pigmentosa) pigmentosum, severe drug photosensitivity (provided that the course of treatment causing the photosensitivity is expected to be of prolonged duration), photophobia associated with an ophthalmic or neurological disorder, or any other condition or disorder causing severe photosensitivity in which the individual is required for medical reasons to be shielded from the direct rays of the sun.
Write the medical condition on the line in "The medical condition of ... warrants a tinted window exemption."
Write the Minimum level of light transmission required due to the above-certified condition.
Write the Reason personal protective measures such as sun-protective clothing, sunscreen, eye-protective devices or clear UV-protective window films do not offer adequate protection.
Physician, physician assistant or nurse practitioner
Write the Physician/Physician Assistant/Nurse Practitioner's Name (please print in full), check Physician, Physician Assistant or Nurse Practitioner, and write the Physician/Physician Assistant/Nurse Practitioner's Mailing Address (include number and street).
Write the City, State, Zip Code, Telephone Number (area code) and the NYS Certificate or Professional License Number.
Check Yes or No on "A copy of my NYS professional license is enclosed with this form."
Sign on the Physician/Physician Assistant/Nurse Practitioner's Signature line and write the Date (Month/Day/Year).
More rules for Form MV-80W
The Vehicle and Traffic Law prohibits most window tint that does not allow at least 70% of any light to pass through.
The person who requests an exemption may be either the driver or someone who is a regular, habitual passenger in the vehicle (see Vehicle and Traffic Law section 375).
NYS Health Department regulations specify that only certain medical conditions can be used to justify an exemption from the limits on light transmittance, and the list of these conditions is on page 2.
Page 1 of this application is to be completed by the person requesting the tinted window exemption, and page 2 must be completed by a NYS licensed physician, physician assistant or nurse practitioner. Send the following items to the address at the bottom of this page: this completed application, a copy of the NYS professional license of the medical provider that completed page 2, and a photocopy of your NYS vehicle registration.
Common questions about Form MV-80W
How do I qualify for tint exemption in NY?
The law provides an exemption for any person who, for medical reasons, must be shielded from direct sunlight, but only when personal protective measures such as sun-protective clothing, sunscreen, eye-protective devices, or clear UV-protective window films do not offer adequate protection, and only when such person has a specific medical condition set forth by the Department of Health.
Where do I file it?
Return this application to: Department of Motor Vehicles, Driver Regulation Bureau, Medical Review Unit, 6 Empire State Plaza, Room 337, Albany NY 12228.
Sources
[1] Form MV-80W (6/24), Application for Tinted Window Exemption (the Official source link on this page).