Form MVR32-6-230 "Application for Disability Access Parking Credentials" - Alabama

What Is Form MVR32-6-230?

This is a legal form that was released by the Alabama Department of Revenue - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the Alabama Department of Revenue;
  • 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 printable version of Form MVR32-6-230 by clicking the link below or browse more documents and templates provided by the Alabama Department of Revenue.

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Download Form MVR32-6-230 "Application for Disability Access Parking Credentials" - Alabama

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A
D
R
LABAMA
EPARTMENT OF
EVENUE
MVR 32-6-230     
8/20
M
V
D
OTOR
EHICLE
IVISION
OFFICIAL USE ONLY
www.revenue.alabama.gov
PLACARD AND/OR LICENSE
Application For Disability Access Parking Credentials
PLATE NUMBER ASSIGNED
_______________
_______________
Return this application to your local licensing office
APPLICANT INFORMATION
Disability Access license plate(s) and placard(s) may be issued to an individual with a disability or a parent, stepparent, or legal guardian of an individual with a
disability. Permanent Disability Applicants are eligible for (2) disability placards per person or (1) license plate per vehicle and (1) placard per person.
Organizations that transport individuals with a disability are only eligible to apply for a Disability Access license plate. There is no fee for placards.
6
6
6
Individual
Parent, Stepparent, or Legal Guardian of an individual with a Disability
Organization
APPLICANT NAME
COUNTY
TELEPHONE NUMBER
(          )
PHYSICAL ADDRESS
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL)
CITY
STATE
ZIP
CITY
STATE
ZIP
DRIVER’S LICENSE (OR NON-DRIVER ID)
ISSUING STATE
EXPIRATION DATE (MONTH/YEAR)
EMAIL ADDRESS
/
FEDERAL EMPLOYER IDENTIFICATION NUMBER (ORGANIZATION ONLY)
CREDENTIALS BEING REQUESTED:
APPLICATION TYPE:
6
6
NEW
RENEWAL
6
DISABILITY ACCESS LICENSE PLATE: (Permanent Disability only)
6
REPLACEMENT
6
Please select reason for replacement below:
DISABILITY ACCESS PLACARD(S)
6
6
6
Lost
Stolen
Mutilated
Applicant certifies, under penalty of perjury, that the applicant meets the requirements necessary to receive disability access parking credentials.
APPLICANT SIGNATURE
DATE
REQUIREMENTS AND CERTIFICATION
An individual with qualified disabilities must obtain certification from a licensed physician, certified registered nurse practitioner, or certified nurse
midwife prior to the initial issuance of disability access credentials. An individual with permanent disabilities may self-certify their qualifying disability
if they are renewing their disability access credentials. A separate certification is not required to obtain replacement disability access credentials.
An individual with disabilities which limits or impairs their ability to walk means (check all that apply):
6
Cannot walk two hundred feet without stopping to rest;
6
Cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device;
6
Are restricted by lung disease to such an extent 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 60 mm.hg on room air at rest;
6
Use portable oxygen;
6
Have a cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to standards set by
the American Heart Association;
6
Are severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition.
Please check below the length of disability:
6
Permanent Disability.
6
Temporary Disability (period not to exceed six months). Beginning Date: ______________________ Ending Date: _______________________
The undersigned affirms under penalty of perjury that the applicant has the specific disability(ies):
AUTHORIZED SIGNATURE (Must be physician, certified registered nurse practitioner or certified nurse midwife signature)
DATE
(          )
PRINTED NAME
MEDICAL LICENSE NUMBER (IF APPLICABLE)
TELEPHONE NUMBER
OFFICE ADDRESS
CITY
STATE
ZIP
A
D
R
LABAMA
EPARTMENT OF
EVENUE
MVR 32-6-230     
8/20
M
V
D
OTOR
EHICLE
IVISION
OFFICIAL USE ONLY
www.revenue.alabama.gov
PLACARD AND/OR LICENSE
Application For Disability Access Parking Credentials
PLATE NUMBER ASSIGNED
_______________
_______________
Return this application to your local licensing office
APPLICANT INFORMATION
Disability Access license plate(s) and placard(s) may be issued to an individual with a disability or a parent, stepparent, or legal guardian of an individual with a
disability. Permanent Disability Applicants are eligible for (2) disability placards per person or (1) license plate per vehicle and (1) placard per person.
Organizations that transport individuals with a disability are only eligible to apply for a Disability Access license plate. There is no fee for placards.
6
6
6
Individual
Parent, Stepparent, or Legal Guardian of an individual with a Disability
Organization
APPLICANT NAME
COUNTY
TELEPHONE NUMBER
(          )
PHYSICAL ADDRESS
MAILING ADDRESS (IF DIFFERENT FROM PHYSICAL)
CITY
STATE
ZIP
CITY
STATE
ZIP
DRIVER’S LICENSE (OR NON-DRIVER ID)
ISSUING STATE
EXPIRATION DATE (MONTH/YEAR)
EMAIL ADDRESS
/
FEDERAL EMPLOYER IDENTIFICATION NUMBER (ORGANIZATION ONLY)
CREDENTIALS BEING REQUESTED:
APPLICATION TYPE:
6
6
NEW
RENEWAL
6
DISABILITY ACCESS LICENSE PLATE: (Permanent Disability only)
6
REPLACEMENT
6
Please select reason for replacement below:
DISABILITY ACCESS PLACARD(S)
6
6
6
Lost
Stolen
Mutilated
Applicant certifies, under penalty of perjury, that the applicant meets the requirements necessary to receive disability access parking credentials.
APPLICANT SIGNATURE
DATE
REQUIREMENTS AND CERTIFICATION
An individual with qualified disabilities must obtain certification from a licensed physician, certified registered nurse practitioner, or certified nurse
midwife prior to the initial issuance of disability access credentials. An individual with permanent disabilities may self-certify their qualifying disability
if they are renewing their disability access credentials. A separate certification is not required to obtain replacement disability access credentials.
An individual with disabilities which limits or impairs their ability to walk means (check all that apply):
6
Cannot walk two hundred feet without stopping to rest;
6
Cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device;
6
Are restricted by lung disease to such an extent 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 60 mm.hg on room air at rest;
6
Use portable oxygen;
6
Have a cardiac condition to the extent that the person’s functional limitations are classified in severity as Class III or Class IV according to standards set by
the American Heart Association;
6
Are severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition.
Please check below the length of disability:
6
Permanent Disability.
6
Temporary Disability (period not to exceed six months). Beginning Date: ______________________ Ending Date: _______________________
The undersigned affirms under penalty of perjury that the applicant has the specific disability(ies):
AUTHORIZED SIGNATURE (Must be physician, certified registered nurse practitioner or certified nurse midwife signature)
DATE
(          )
PRINTED NAME
MEDICAL LICENSE NUMBER (IF APPLICABLE)
TELEPHONE NUMBER
OFFICE ADDRESS
CITY
STATE
ZIP