Form SP-120 "Application for Nursing Home Resident Parking Placard" - New Jersey

What Is Form SP-120?

This is a legal form that was released by the New Jersey Motor Vehicle Commission - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the New Jersey Motor Vehicle Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form SP-120 by clicking the link below or browse more documents and templates provided by the New Jersey Motor Vehicle Commission.

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Download Form SP-120 "Application for Nursing Home Resident Parking Placard" - New Jersey

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Application for Nursing Home
Resident Parking Placard
Management Operation Services
Special Plate Unit
225 East State Street
P.O. Box 015
Trenton, NJ 08666
609-292-6500 ext. 5061
Instructions – Please read carefully
Type or print clearly. Enter the vehicle description exactly as it appears on the vehicle registration.
Enclose a photocopy of the current registration certificate.
Nursing home owner or operator must sign the application.
Issuance of this placard is limited to a nursing home owner or operator for use in a vehicle owned or operated by the nursing
home when the vehicle is used to transport nursing home residents with disabilities. A photocopy of your “Certificate to Operate
a Nursing Home,” issued by the Department of Health, must accompany this application. There is no charge for this placard.
Name of Owner/Operator ____________________________________________________________________________________________
Owner/Operator’s Driver License Number _________________________________________________________________________________
License Plate Number _____________________________________________ Expiration Date ______________________________________
Nursing Home Name _________________________________________________________________________________________________
Nursing Home Corp Code Number ______________________________________________________________________________________
Nursing Home Telephone Number ______________________________________________________________________________________
Street Address ______________________________________________________________________________________________________
City, State, Zip Code _________________________________________________________________________________________________
Make ______________________________ Year ____________________ Color ____________________ Body ________________________
Vehicle Identification Number __________________________________________________________________________________________
Print Name of Nursing Home Owner/Operator ______________________________________________________________________________
Signature of Nursing Home Owner/Operator _____________________________________________ Date _____________________________
Motor Vehicle Commission Use Only:
Employee Initials:
Placard Number:
Date Issued:
Expiration Date:
Visit us at
www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
SP-120 (R8/19)
Application for Nursing Home
Resident Parking Placard
Management Operation Services
Special Plate Unit
225 East State Street
P.O. Box 015
Trenton, NJ 08666
609-292-6500 ext. 5061
Instructions – Please read carefully
Type or print clearly. Enter the vehicle description exactly as it appears on the vehicle registration.
Enclose a photocopy of the current registration certificate.
Nursing home owner or operator must sign the application.
Issuance of this placard is limited to a nursing home owner or operator for use in a vehicle owned or operated by the nursing
home when the vehicle is used to transport nursing home residents with disabilities. A photocopy of your “Certificate to Operate
a Nursing Home,” issued by the Department of Health, must accompany this application. There is no charge for this placard.
Name of Owner/Operator ____________________________________________________________________________________________
Owner/Operator’s Driver License Number _________________________________________________________________________________
License Plate Number _____________________________________________ Expiration Date ______________________________________
Nursing Home Name _________________________________________________________________________________________________
Nursing Home Corp Code Number ______________________________________________________________________________________
Nursing Home Telephone Number ______________________________________________________________________________________
Street Address ______________________________________________________________________________________________________
City, State, Zip Code _________________________________________________________________________________________________
Make ______________________________ Year ____________________ Color ____________________ Body ________________________
Vehicle Identification Number __________________________________________________________________________________________
Print Name of Nursing Home Owner/Operator ______________________________________________________________________________
Signature of Nursing Home Owner/Operator _____________________________________________ Date _____________________________
Motor Vehicle Commission Use Only:
Employee Initials:
Placard Number:
Date Issued:
Expiration Date:
Visit us at
www.NJMVC.gov
New Jersey is an Equal Opportunity Employer
SP-120 (R8/19)