Texas Form Vi 4 – Fill Out and Use This PDF

The Texas VI-4 form, administered by the Texas Department of Public Safety Regulatory Services Division, is a document designed specifically for individuals seeking a medical exemption from the state’s window tint laws. This form allows applicants to provide necessary information about themselves, their vehicles, and the medical rationale behind the need for a darker window tint than state regulations typically permit. If you or someone you know requires a window tint exemption due to medical reasons, ensuring the form is filled out accurately and submitted with the proper documentation is crucial. Click the button below to begin the process.

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Texas Form Vi 4 PDF Details

In the state of Texas, the balance between public safety and individual needs takes a practical form through the Texas Department of Public Safety's Vehicle Inspection criteria, specifically regarding window tint regulations. Individuals with certain medical conditions that necessitate protection from the sun's rays are offered a potential exemption from the standard window tint laws, and this is where the Texas VI-4 form becomes essential. This form serves as an application for a medical exemption to the state's window tint rules. It demands detailed information including the applicant's name as it appears on their driver's license, contact information, vehicle details, and a physician, optometrist, or ophthalmologist's certification. Furthermore, it underscores the necessity of accuracy and honesty, cautioning applicants that any false statements may lead to criminal violations under the penalty of perjury. The process of applying, which includes supporting documents such as a doctor's letter or prescription, is streamlined with clear instructions on how to submit the application, whether by secured email, fax, or standard mail. Moreover, applicants are advised to allot up to fifteen working days for the processing of their application to obtain an exemption certificate, emphasizing the state's commitment to thorough and considerate evaluation of each case. This form exemplifies Texas's thoughtful approach to accommodating residents' health-related needs while maintaining safety and regulatory standards.

Question	Answer
Form Name	Texas Form Vi 4
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	tint exemption texas, texas window tint exemption form, medical tint exemption texas, texas tint exemption

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Texas Department of Public Safety Regulatory Services Division www.dps.texas.gov

MUST USE MOST CURRENT FORM

FORM MUST BE TYPED

VEHICLE INSPECTION WINDOW TINT

		FOR DPS USE ONLY
APPLICATION FOR WINDOW TINT MEDICAL EXEMPTION
APPLICANT (PLEASE USE NAME AS IT APPEARS ON DRIVER LICENSE)
Name	DL #	State	Expiration

	Patient Name	Relationship to Applicant
	(IF DIFFERENT FROM APPLICANT)	Relationship to Applicant
	(IF DIFFERENT FROM APPLICANT)

Residence	City	State	County	ZIP
Address	City	State	County	ZIP
Address

Mailing	City	State	County	ZIP
Mailing
Address
Address

Date of Birth

Home Phone	Cell Phone
Business Phone	Other Phone

VEHICLE INFORMATION

Vehicle #1

VIN

Year

Make

Model

VEHICLE #2

VIN

Year

Make

Model

VEHICLE #3

VIN

Year

Make

Model

PHYSICIAN, OPTOMETRIST OR OPHTHALMOLOGIST

Name

Address

		License #

	City	State	Zip

Phone		Fax

Vehicle Owner Certiication

I certify and afirm that all information presented in this form is true and correct, that any documents I have presented to DPS are genuine, and that the information included in all supporting documentation is true and accurate. I make this certiication and afirmation under penalty of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.

Applicant / Legal Guardian’s Signature

Date

Completed application must be accompanied by one of the following:

●Letter, on physician letterhead, signed by the physician, indicating the medical reason for the exemption.

●An original prescription including the applicant’s name, physician’s signature and indicating the medical reason for the exemption.

Letters and prescriptions must be dated within one year of exemption request. If the exemption is approved, an exemption letter will be sent to the applicant listed above.

SUBMIT completed form with required documentation:

●Online Secured Email

➢Contact Us, select “Vehicle Inspection” and complete the online form.

➢http://www.txdps.state.tx.us/rsd/contact/default.aspx

●Fax to (512) 424-2774

●Mailing Address: Texas Department of Public Safety

Regulatory Services Division, Compliance & Enforcement Service

Window Tint Medical Exemption

P. O. Box 4087

Austin, Texas 78773-0543

Please allow up to 15 working days for your application to be processed, approved and to receive your exemption certiicate.

VI-4 (Rev. 3/16)

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2. Once your current task is complete, take the next step – fill out all of these fields - License, State, Fax, Zip, PHYSICIAN OPTOMETRIST OR, Name, Address, Email, City, Phone, Vehicle Owner Certiication, I certify and afirm that all, Applicant Legal Guardians, Date, and Completed application must be with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

City, Email, and Date in texas window tint exemption

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Texas Form Vi 4 – Fill Out and Use This PDF

Texas Form Vi 4 PDF Details

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