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INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A METERED PARKING WAIVER

The metered parking waiver is intended for use by those individuals whose severe disabilities make it extremely difficult to put payment

into a parking meter when traveling alone. Any person who makes a false statement or gives information which is known to be false to a

public official to obtain a metered parking waiver may be subject to a civil penalty of $250-$1,000 and possible criminal prosecution.

New York City Residents - New York City does not issue the Metered Parking Waiver because the New York City parking permit

allows the permit holder to park in metered parking spaces within New York City and not pay the meter fee. For more information

about the City permit, call (718) 433-3100 or contact the New York City Department of Transportation at:

New York City Department of Transportation

Permits and Customer Service

30-30 Thomson Avenue, 2nd Floor

Long Island City, NY 11101-3045

STEP 1 - Metered Parking Waiver Requirements

In order to be eligible for the metered parking waiver, you must meet all of the following conditions:

1. Be a resident of New York State; and

2. Be a resident of the city, town, or village in which you are obtaining the waiver (New York City residents are not eligible as

explained above); and

3. Hold a valid New York State driver license; and

4. Are severely disabled as defined in Vehicle and Traffic Law Section 404-a (see Part A on page 1); and

5. Your severe disability as certified by a licensed physician, physician assistant, or doctor of osteopathy limits one or more of

the following:

a. Fine motor control in both hands; or

b. Ability to reach or access a parking meter due to use of a wheelchair or other ambulatory device; or

c. Ability to reach a height of 42 inches from the ground due to lack of finger, hand or upper extremity strength or mobility.

Do you meet all of the requirements listed above in 1-5?

If No, you are not eligible for a metered parking waiver.

If Yes, continue on to Step 2.

STEP 2 - Complete the section “Information About Person with Disability”.

•

Clearly print your personal information in the boxes provided.

•

Print your New York State driver license number and expiration date in the space provided. Your driver license number is

the 9 digit ID number located near your picture. The expiration date is printed in red on the bottom of the license. This

number needs to be a date in the future.

•

If you have license plates with the International Symbol of Access, check “Yes” and write your plate number in the space

provided. If you do not have those plates, check “No”.

•

If you have a permanent (blue) parking permit for people with severe disabilities, check “Yes” and write the permit number in

the space provided. The permit number is a 6 or 7 digit number printed in black along the top portion of the permit. If you do

not have a permanent permit, check “No”.

•

Read the certification statement and sign the form in the space provided.

STEP 3 - Have your doctor fill out the Medical Certification section.

•

Bring the application form to your physician, physician assistant(PA), or doctor of osteopathy(DO). This form can only be

filled out by a physician/PA/DO, not a nurse practitioner, chiropractor, or podiatrist.

•

The physician/PA/DO should read Part A and read and fill out Part B by checking all of the disabilities that apply.

•

The physician/PA/DO should print his or her name, license number, address and telephone number in the space provided.

•

The physician/PA/DO must sign and date the form. (NOTE: Original signatures only.)

STEP 4 - Bring your completed application to the issuing agent in the area where you live to receive a waiver.

Issuing agents are often the town, village or city clerk or the local police department. You can not obtain a metered parking waiver

from any State or County Motor Vehicles office. Call your local city, town or village hall to find out where to apply for the waiver. If

you are a resident of Nassau County, call (516) 227-7399 to find out where to apply.

dmv.ny.gov

PAGE 2 OF 2

MV-664.1MP (2/17)

Form Mv-664.1mp - Application For A Metered Parking Waiver For Persons With Severe Disabilities Page 2

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