Form Mv-145a - Person With Disability Parking Placard Application Page 2

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INSTRUCTIONS

1. Permanent Placard - Complete Sections A, B or C (NOT BOTH) and E. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in

the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).

2. Severely Disabled Veteran Placard - Complete Sections A, D and E.

3. Temporary Placard - Complete Sections A, B and E. NOTE: Only licensed health care providers* may certify disabilities for temporary placards. Temporary

placards may be issued for a period up to six months and may not be extended for an additional period of time. When additional time is needed,

a new application must be completed and certified by a health care provider. In addition, please list your previous placard number.

4. Renewal Request - Complete Sections A and E. NOTE: Notarization is not required.

5. Replacement Request - Indicate if applying for a replacement placard or ID card. Please check reason for replacement; Lost, Stolen, Defaced or Never

Received. List your previous placard number and complete Sections A and E. NOTE: If product was not received within 90 days, please check the

"Never Received" box or if product was not received for over 90 days please check the "Lost" box.

6. Change of Address - Complete Sections A and E. NOTE: Notarization is not required.

7. Change of Name - Complete Sections A and E. Check the block on the front of this application to indicate reason for change of name. NOTE:

Notarization is not required.

health Care Provider is defined as a physician, chiropractor, podiatrist, physician’s assistant or a certified registered nurse practitioner licensed

or certified in Pennsylvania or a contiguous state. health care providers may only certify disabilities within their scope of practice.

Placard Type

Eligibility Requirements

Qualifying Vehicles

benefits

“Reason Codes”

Person with

(1) A passenger vehicle or truck with a

(1) Parking

permitted

Applicant:

Disability

registered gross weight of not more than

spaces designated for

(1) is blind.

Placard

14,000 lbs.

disabled persons and for

(2) does not have full use of an arm or both arms.

60 minutes in excess of

(2) The placard is required to be displayed

legal

parking

period

(3) cannot walk 200 feet without stopping to rest.

when the vehicle is parked in areas

except

where

local

(4) cannot walk without the use of, or assistance

designated for use by persons with

ordinances

police

from, a brace, cane, crutch, another person,

disability only and must not be displayed

regulations provide for

prosthetic device, wheelchair or other assistive

when the vehicle is being operated on

the accommodation of

device.

the highway.

heavy

traffic

during

(5) is restricted by lung disease to such an extent

NOTE:

Organizations

that

operate

morning, afternoon or

that the person’s forced (respiratory) expiratory

passenger vehicle to transport persons with

evening hours.

volume for one second, when measured by

disabilities must supply the Department with

(2) Upon

request

spirometry, is less than one liter or the arterial

the following:

person with disability,

oxygen tension is less than 60 MM/HG on room

a) A notarized statement of how the

local

authorities

may

air at rest.

placard will be used and the type of

erect on the highway as

(6) uses portable oxygen.

services that will be provided.

close as possible to the

(7) has a cardiac condition to the extent that the

person’s residence a

b) The weekly or monthly number of

person’s functional limitations are classified in

sign(s) indicating that the

hours that the services are provided.

severity as Class III or Class IV according to the

place is reserved for the

c) The make of the vehicle(s), including

standards

set

the

American

Heart

person with disability,

the title number, vehicle identification

Association.

that no one else may

number

and

registration

plate

(8) is severely limited in his or her ability to walk due

park there unless a

number. The vehicle(s) must be titled

to an arthritic, neurological or orthopedic condition.

person with disability

in the name of the organization and

plate

placard

(9) is a person in loco parentis of a person specified in

must be a passenger vehicle.

displayed and that any

paragraph (1), (2), (3), (4), (5), (6), (7) or (8) above.

d) The number of placards required:

unauthorized

person

(10) is the parent, including adoptive parent or foster

(Organizations may not be issued

parking there will be

parent, of a child or adult child provided that the

more than eight placards in the

subject to a fine.

person has custody, care or control of the child or

organization’s name.)

adult child and the child or adult child satisfies

paragraph (1), (2), (3), (4), (5), (6), (7) or (8).

(11) is the spouse of a person specified in paragraph (1),

(2), (3), (4), (5), (6), (7) or (8).

Definition of Person in Loco Parentis - ANY ADULT charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a minor

child (under 18) in place of the child’s natural parents.

(1) 100% service-connected disability certified by the

Same as 1 and 2 above for Person with

Same as above for Person

Severely

U.S. Department of Veterans Affairs (Pittsburgh or

Disability Placard.

with Disability Placard.

Disabled

Philadelphia) or service unit in which the veteran

Veteran

served or as shown on the applicant’s Letter of

Placard

Promulgation or Awards Letter.

(2) Same disabilities as listed above for Person with

Disability Placard but must be service-connected.

Use of Person with Disability and Severely Disabled Veteran Placards:

Placards are to be used only when the vehicle in which it is displayed is parked and is being used for the transportation of the person with disability or

severely disabled veteran.

Any vehicle lawfully displaying a placard will qualify for parking in areas designated for use by persons with a disability only.

The placard will not allow vehicles to park where parking is prohibited.

Send completed application to: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268

Visit us at or call us at 717-412-5300. TTY callers — please dial 711 to reach us.