In the state of Maine, addressing the needs of individuals who cannot wear seat belts due to medical conditions is taken seriously, as evidenced by the Maine Bureau of Motor Vehicles' Application for Seat Belt Exemption, known as the PS-15 form. This document serves as a critical bridge for those seeking relief from the legal requirement to wear a seat belt while operating or riding in a vehicle. Applicants must fill out the form with their personal information, alongside a physician's detailed statement justifying the exemption, which is valid for no more than one year. The form is meticulously designed to ensure that once issued, the removable windshield placard provided does not obstruct the driver's view, demonstrating a thoughtful balance between legal exemptions and road safety. Whether individuals are applying for the first time, reapplying, or requesting a replacement, this process underscores the importance of accommodating all drivers and passengers, ensuring their safety and comfort without compromising the standards set forth for road safety.
| Question | Answer |
|---|---|
| Form Name | Ps 15 Form Maine |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | removable, Exp, Placard, rearview |
MAINE BUREAU OF MOTOR VEHICLES
APPLICATION FOR SEAT BELT EXEMPTION
___ New Application ___
Applicant’s Name:________________________________________
Address: _______________________________________________
_______________________________________________
BMV Use Only
Placard #: ________________
Issue Date: _______________
Exp Date: ________________
Returned #: _______________
Replaced #: _______________
Issued By: ________________
Entered: __________________
Daytime Phone #: ______________________________ DOB: _____________
Applicant’s Statement of Understanding:
This removable windshield placard is designed to hang from the rearview mirror when the vehicle is in motion without obstructing the view of the operator. If the vehicle is not equipped with a rearview mirror, the placard must be displayed on the dashboard. A placard issued to a person expires when the physician's certificate expires which may not exceed one year.
Applicant’s Signature:_____________________________________________ Date: _________________
/////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////
Physician’s Statement:
This seatbelt exemption should expire on ___________________ (may not exceed one year).
This patient has a medical condition that warrants an exemption from the requirements of having to wear a seatbelt while riding in or operating a motor vehicle.
The patient’s specific condition is:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Wearing a seatbelt is a risk for this patient because:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Physician’s Printed Name: ____________________________________________________________________
Signature: ________________________________________________________________Date _____________
Physician’s Address: ________________________________________ License #: ______________________
__________________________________________________________ Phone #: ______________________________
Phone: |
Fax: |
Mail to: Bureau of Motor Vehicles |
Attn: Disability Section |
29 SHS Augusta ME