Form Mv-145a - 2013 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 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 not received within 90 days, please check the

"Never Received" box or if product 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 here to indicate reason for change of name:

Marriage

Divorce

Other ___________

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

10,000 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

designated for use by persons with

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

ordinances

police

disability only and must not be displayed

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

regulations provide for

when the vehicle is being operated on

prosthetic device, wheelchair or other assistive

the accommodation of

the highway.

device.

heavy

traffic

during

NOTE:

Organizations

that

operate

morning, afternoon or

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

passenger vehicle to transport persons with

evening hours.

that the person’s forced (respiratory) expiratory

disabilities must supply the Department with

volume for one second, when measured by

(2) Upon

request

the following:

spirometry, is less than one liter or the arterial

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

services that will be provided.

close as possible to the

(6) uses portable oxygen.

person’s residence a

b) the weekly or monthly number of

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

sign(s) indicating that the

hours that the services are provided.

person’s functional limitations are classified in

place is reserved for the

severity as Class III or Class IV according to the

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

person with disability,

standards

set

the

American

Heart

the title number, vehicle identification

that no one else may

Association.

number

and

registration

plate

park there unless a

number. The vehicle(s) must be titled

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

person with disability

in the name of the organization and

to an arthritic, neurological or orthopedic

plate

placard

must be a passenger vehicle.

condition.

displayed and that any

d) the number of placards required:

unauthorized

person

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

(Organizations may not be issued

parking there will be

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

more than eight placards in the

subject to a fine.

above.

organization’s name.)

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.

Severely

(1) 100% service-connected disability certified by

Same as 1 and 2 above for Person with

Same as above for Person

Disabled

U.S. Veteran’s Administration; or the service unit

Disability Placard.

with Disability Placard.

Veteran

of the armed forces in which the veteran served.

Placard

(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:

PA Department of Transportation

Bureau of Motor Vehicles

P.O. Box 68268

Harrisburg, PA 17106-8268

Visit us at or call us at:

In state: 1-800-932-4600

TDD: 1-800-228-0676

Out-of-State: 1-717-412-5300