Form SP59 "Expedited Service Permit Application" - Nevada

What Is Form SP59?

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

Form Details:

  • Released on September 29, 2015;
  • The latest edition provided by the Nevada Department of Motor Vehicles;
  • 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 SP59 by clicking the link below or browse more documents and templates provided by the Nevada Department of Motor Vehicles.

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Download Form SP59 "Expedited Service Permit Application" - Nevada

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555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
Fax (775) 684-4797
www.dmvnv.com
EXPEDITED SERVICE PERMIT APPLICATION
NRS426.441
Nevada law allows for issuance of an Expedited Service Permit for individuals with a permanent (irreversible) disability.
This permit entitles a person to expedited service from any officer or employee of a State agency providing public
services. The Expedited Service Permit is valid for 10 years from date of issuance.
Original and duplicate application for an Expedited Service Permit must be made in person.
Original Application
Duplicate or Change
Renewal
Please Print or Type
Full Legal Name
(Disabled Person)
First
Middle
Last
Nevada Driver’s License or Identification Card Number
Date of Birth
/
/
Physical Address
Address
City
State
Zip Code
Mailing Address
Address
City
State
Zip Code
County of Residence
Telephone No.
Email Address
I currently have Disabled License Plate number ____________ I currently have Disabled Placard(s) number(s): __________________
I understand that it is unlawful for any individual other than myself to use or attempt to use this Expedited Service Permit and that a
person who violates this provision is guilty of a misdemeanor.
Signature of Applicant
Date
Fees for original, duplicate, or renewal:
65 years of age or older - $8.25
Under 18 years of age - $7.25
All others - $13.25
New photograph, change of name or both - $8.25
There has been a $1.00 Technology fee associated to each transaction.
A LICENSED PHYSICIAN MUST COMPLETE THIS PORTION
Do not complete this section for renewal or duplicate if you have previously provided the Nevada Department of Motor
Vehicles with a physician’s certificate indicating an irreversible condition.
As a physician for the above-named patient, I hereby certify that the applicant:
1. ________
Cannot walk two hundred feet without stopping to rest
2. ________
Cannot walk without the use of a brace, cane, crutch, wheelchair, or other device or another person
3. ________
Has a cardiac condition to the extent that functional limitations are classified as a Class III or Class IV according to
standards adopted by the American Heart Association
4. ________
Is restricted by a lung disease
5. ________
Is severely limited in his/her ability to walk because of an arthritic, neurological, or orthopedic condition
6. ________
Has a disability that affects vision
7. ________
Uses portable oxygen
I further certify that my patient’s condition is a:
Permanent Disability (irreversible, permanently disabled in his/her ability to walk, certification is valid indefinitely)
Physician’s Name
First
Middle
Last
Mailing Address
Address
City
State
Zip Code
Physician’s License No.
Telephone No
Physician’s Signature
Date
SP59 (Rev 09-29-2015)
555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
Fax (775) 684-4797
www.dmvnv.com
EXPEDITED SERVICE PERMIT APPLICATION
NRS426.441
Nevada law allows for issuance of an Expedited Service Permit for individuals with a permanent (irreversible) disability.
This permit entitles a person to expedited service from any officer or employee of a State agency providing public
services. The Expedited Service Permit is valid for 10 years from date of issuance.
Original and duplicate application for an Expedited Service Permit must be made in person.
Original Application
Duplicate or Change
Renewal
Please Print or Type
Full Legal Name
(Disabled Person)
First
Middle
Last
Nevada Driver’s License or Identification Card Number
Date of Birth
/
/
Physical Address
Address
City
State
Zip Code
Mailing Address
Address
City
State
Zip Code
County of Residence
Telephone No.
Email Address
I currently have Disabled License Plate number ____________ I currently have Disabled Placard(s) number(s): __________________
I understand that it is unlawful for any individual other than myself to use or attempt to use this Expedited Service Permit and that a
person who violates this provision is guilty of a misdemeanor.
Signature of Applicant
Date
Fees for original, duplicate, or renewal:
65 years of age or older - $8.25
Under 18 years of age - $7.25
All others - $13.25
New photograph, change of name or both - $8.25
There has been a $1.00 Technology fee associated to each transaction.
A LICENSED PHYSICIAN MUST COMPLETE THIS PORTION
Do not complete this section for renewal or duplicate if you have previously provided the Nevada Department of Motor
Vehicles with a physician’s certificate indicating an irreversible condition.
As a physician for the above-named patient, I hereby certify that the applicant:
1. ________
Cannot walk two hundred feet without stopping to rest
2. ________
Cannot walk without the use of a brace, cane, crutch, wheelchair, or other device or another person
3. ________
Has a cardiac condition to the extent that functional limitations are classified as a Class III or Class IV according to
standards adopted by the American Heart Association
4. ________
Is restricted by a lung disease
5. ________
Is severely limited in his/her ability to walk because of an arthritic, neurological, or orthopedic condition
6. ________
Has a disability that affects vision
7. ________
Uses portable oxygen
I further certify that my patient’s condition is a:
Permanent Disability (irreversible, permanently disabled in his/her ability to walk, certification is valid indefinitely)
Physician’s Name
First
Middle
Last
Mailing Address
Address
City
State
Zip Code
Physician’s License No.
Telephone No
Physician’s Signature
Date
SP59 (Rev 09-29-2015)