Form Mv-664.1s - Application For A Parking Permit Or License Plates, For People With Severe Disabilities (Spanish) Page 4

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NOTA A LOS CLIENTES Y PROFESIONALES MÉDICOS
De acuerdo con la Ley Penal y la Ley de Tránsito y Vehículos de NYS, es un delito (mayor o
menor) presentar una declaración falsa o proporcionar información falsa en una solicitud para
obtener un permiso de estacionamiento o matrícula para una persona con discapacidades graves.
Este delito se puede castigar por medio de una multa, encarcelamiento o ambos. Si este delito
involucra una solicitud de permiso de estacionamiento, también podría resultar en una obligación
de pago de una multa civil de $250 a $1,000.
Para los Clientes que desean obtener matrículas o un permiso de estacionamiento para
personas con una discapacidad:
Al firmar la Parte 1 de esta solicitud, certifica:
que la información que proporciona en la solicitud es verdadera;
l
que ha leído y entendido las condiciones para “Usar matrículas y permisos de estacionamiento” que se
l
encuentra en la página 2; y
que acepta cumplir con estas condiciones.
l
Para los profesionales médicos que proporcionan información médica para respaldar una
solicitud de matrículas o un permiso de estacionamiento para personas discapacitadas:
Al firmar la Parte 2 de esta solicitud, certifica:
que la información médica que proporciona es verdadera y está completa; y
l
que, de acuerdo con su concepto, la persona nombrada en la Parte 1 de la solicitud está médicamente
l
calificada para recibir matrículas o permisos de estacionamiento para personas discapacitadas, según el
criterio médico especificado en la Parte 2.
MV-664.1S (2/17)
dmv.ny.gov
PÁGINA 4 DE 4

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