TC-842: Disability Certification

Enter the Disabled person's name (last, first, middle initial) or business name, the Email address and the Phone number.

Enter the Street address with City, State and ZIP Code.

Enter the Mailing address (if different from Street address) with City, State and ZIP Code.

Enter the Disabled person's ID and check one ID type: Driver's license, SSN, Passport, State ID, Military ID or Foreign ID.

Enter the FEIN (if business).

Under Plate and/or Placard Request, check all that apply.

Disabled person license plate - $21.50 (checked October 31, 2026).

Enter the Current plate number.

You may also receive one permanent placard.

Under Windshield placard: Is this placard for a Wheelchair User? Yes or No.

How many placards would you like? Check one: One or Two. You can only receive one placard if requesting disabled plates.

Under Windshield placard, check one type: Paper (no fee) or Durable material ($2.50 fee per placard) (checked October 31, 2026).

If you check Replacement for windshield placard, enter the Previous placard number(s) and check one type: Paper (no fee) or Durable material ($2.50 fee per placard) (checked October 31, 2026).

Businesses skip to Section 2.

By signing Medical Authorization and Certification you authorize your doctor, doctor's assistant, physical therapist or nurse practitioner to release information about your disability, or the disability of the person named. To the best of your knowledge, the information on this form is true and correct. In the event the disabled person no longer needs the plate and/or placard during the registration period, it will be returned to the Utah State Tax Commission.

Sign as the Applicant's or authorized signature. If authorized signature, enter the relationship to applicant. Enter the Date.

Section 2: Disabled Person Care Facility Certification: by signing, the business certifies that the business named on this form is applying for disabled license plates and/or placards primarily for the purpose of transporting disabled persons meeting the conditions explained in Section 3 while in its care.

Sign the Signature line, then enter the Title and the Date.

Under Section 3: Disability Certification, enter the Name of physician, physician assistant, physical therapist or nurse practitioner, the Phone number, and the Address, City, State and ZIP Code.

Check all conditions that apply to the applicant. For conditions that qualify for a disabled person plate or placard, see Federal Regulations, Title 23 Section 1235.2

Cannot walk 200 feet without stopping to rest.

Cannot walk without a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive devices.

Is restricted by lung disease to such a degree that the person's forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than sixty mm/hg on room air at rest.

Uses portable oxygen.

Has a cardiac condition to the degree that the person's functional limitation is classified (according to American Heart Association standards) in severity as Class III or Class IV.

Is severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition.

Check whether these conditions are permanent or temporary: Permanent, or Temporary and expected to last until (not more than six months).

By signing you certify that you are a licensed physician, physician assistant, physical therapist or nurse practitioner, and that you have treated or are familiar with the medical treatment provided to the person applying for the Disabled Special Group plate and/or placard and that this person's condition is as stated in this section.

Sign the Signature line, then enter the License number and the Date.

Utah State Tax Commission, Motor Vehicle Division, PO Box 30412 Salt Lake City, UT 84130, 801-297-7780 or 1-800-368-8824.

Any violation of the rules is a class C misdemeanor.