Form 10-337 "Vehicle Owner's Application for Issuance of Van Accessible Decal Physician or Advanced Practice Registered Nurse Certification" - Arkansas

What Is Form 10-337?

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

Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Arkansas Department of Finance & Administration;
  • 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 10-337 by clicking the link below or browse more documents and templates provided by the Arkansas Department of Finance & Administration.

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Download Form 10-337 "Vehicle Owner's Application for Issuance of Van Accessible Decal Physician or Advanced Practice Registered Nurse Certification" - Arkansas

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STATE OF ARKANSAS
VEHICLE OWNER’S APPLICATION FOR ISSUANCE OF VAN ACCESSIBLE DECAL
PHYSICIAN OR ADVANCED PRACTICE REGISTERED NURSE CERTIFICATION
TO BE COMPLETED BY A PHYSICIAN
Name of Physician or Advanced Registered Nurse (Print of Type):
Medical License Number:
Address
City, State, Zip
I hereby certify that the applicant below has limited or no use of his or her legs.
Signature Authority:
Date:
TO BE COMPLETED BY APPLICANT
Vehicles qualified to display special decal are as follows: Passenger Vehicles, 1 ton trucks and vans
as rated by the manufacturer which are used only for personal transportation, light trucks and vans
½ and ¾ ton as rated by the manufacturer.
Please indicate where the special decal will be affixed by checking the appropriate Box:
Placard Only
Plate Only
Plate and Placard
(Vehicle Description not applicable)
(Complete Vehicle Description)
(Complete Vehicle Description)
VEHICLE DESCRIPTION
License No
VIN
YEAR
MAKE
MODEL
I hereby certify that as the occupant of the above described vehicle, I am qualified to display the
special decal authorized under Arkansas Code 27-15-302, which states that a designated special decal
to be affixed to a special license plate, special certificate, or temporary special certificate and
displayed on a vehicle that is used to transport a person who has limited or no use of his or her legs;
and used to transport a wheelchair, a three-wheeled or four-wheeled scooter, a four-wheeled walker
with a seat , or a similar device.
Applicant’s Printed Name:
Applicant’s Signature:
Date:
Guardians Name and Signature (if applicable):
Applicant’s Address
City, State, Zip
REVENUE OFFICE USE ONLY: Special Van Accessible Decal Number
10-337
11/17
STATE OF ARKANSAS
VEHICLE OWNER’S APPLICATION FOR ISSUANCE OF VAN ACCESSIBLE DECAL
PHYSICIAN OR ADVANCED PRACTICE REGISTERED NURSE CERTIFICATION
TO BE COMPLETED BY A PHYSICIAN
Name of Physician or Advanced Registered Nurse (Print of Type):
Medical License Number:
Address
City, State, Zip
I hereby certify that the applicant below has limited or no use of his or her legs.
Signature Authority:
Date:
TO BE COMPLETED BY APPLICANT
Vehicles qualified to display special decal are as follows: Passenger Vehicles, 1 ton trucks and vans
as rated by the manufacturer which are used only for personal transportation, light trucks and vans
½ and ¾ ton as rated by the manufacturer.
Please indicate where the special decal will be affixed by checking the appropriate Box:
Placard Only
Plate Only
Plate and Placard
(Vehicle Description not applicable)
(Complete Vehicle Description)
(Complete Vehicle Description)
VEHICLE DESCRIPTION
License No
VIN
YEAR
MAKE
MODEL
I hereby certify that as the occupant of the above described vehicle, I am qualified to display the
special decal authorized under Arkansas Code 27-15-302, which states that a designated special decal
to be affixed to a special license plate, special certificate, or temporary special certificate and
displayed on a vehicle that is used to transport a person who has limited or no use of his or her legs;
and used to transport a wheelchair, a three-wheeled or four-wheeled scooter, a four-wheeled walker
with a seat , or a similar device.
Applicant’s Printed Name:
Applicant’s Signature:
Date:
Guardians Name and Signature (if applicable):
Applicant’s Address
City, State, Zip
REVENUE OFFICE USE ONLY: Special Van Accessible Decal Number
10-337
11/17