Please rate State Form 42070 R21 - 6-26
To apply for a disability parking placard, complete Sections 1 and 3.
Section 4: the health care provider's certification that the applicant has a qualifying disability, permanent or temporary.
Parents: parents may sign this form on behalf of a minor child without any documentation.
Other signers: any other person signing on behalf of the applicant must provide a copy of the document that authorizes that person to sign.
Social Security Number: disclosure is voluntary and you will not be penalized for refusal.
| Question | Answer |
|---|---|
| Form Name | State Form 42070 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 63 |
| Avg. time to fill out | 11 min |
| Edition | R21 / 6-26 |
| Issuing agency | Indiana Bureau of Motor Vehicles |
| Health care provider | Must complete Section 4 except when the applicant is a company, is requesting a replacement parking placard, or has received or is eligible to receive a Disabled Hoosier Veteran license plate |
| Where to mail | Winchester Mail Processing Center |
| Other names | State Form 42070, Indiana State Form 42070, Form 42070, 42070, Application for Disability License Plate or Parking Placard |
| Official source | State Form 42070 (Rev R21 / 6-26), Indiana Bureau of Motor Vehicles |
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Please rate State Form 42070 R21 - 6-26
