Fillable Form Mv-90 - Disabled Person'S Parking Affidavit (Page 2 of 2) in pdf

MV-9D Instructions (Revised 05-2006)

Instructions for Applying for a Disabled Person’s License Plate or Permanent or

Temporary Permit (Placard)

Except for signature(s), this application must be typed, electronically completed and printed or legibly printed

by hand for signing and submission.

Note:

Vehicle owner information is only required when applying for a disabled person’s license plate. You do

not have to own a vehicle to obtain a disabled person’s parking permit (placard).

Section One

*Record the vehicle owner’s full legal name, valid driver’s license number and the name of the

issuing state if applying for a disabled person’s license plate.

*Record the vehicle owner’s street address including the city, state and zip code if applying for a

disabled person’s license plate.

*Enter the county name where the vehicle owner resides if applying for a disabled person’s license

plate.

*Check the box to indicate the disabled person’s relationship to the vehicle owner, e.g. child, self,

spouse or ward, if applying for a disabled person’s license plate.

Enter the disabled person’s full legal name.

Enter the disabled person’s street address including the city, state and zip code.

Section Two – For Institutions Only

For institutions only, enter

•

The institution’s full legal name

•

A description of the vehicle, e.g. vehicle year and make, vehicle identification number, vehicle

color and vehicle license plate number

•

The institution’s authorized agent must sign and enter his/her position or job title with the

institution.

•

A copy of the institutional license must be attached.

Section Three

Check the box(s) indicating what you are applying for, e.g. temporary parking permit (placard);

permanent parking permit (placard); special permanent parking permit (placard) or disabled

person’s license plate. You may apply for both a disabled person’s parking permit (placard) and a

disabled person’s license plate with this form by checking the applicable boxes.

Note: Disabled person’s license plates are issued to individuals, not to institutions.

Section Four

The practitioner of the healing arts must:

Check the applicable box to indicate whether the disability is permanent or temporary.

Check the applicable box to indicate the type of disability.

Section Five

The practitioner of the healing arts must:

Print his/her full legal name, record his/her Georgia license number, sign and enter the date

signed.

Record his/her office street address including the city, state and zip code and his/her business

telephone number, including the area code.

Note: This form must be completed and signed by a licensed practitioner of the healing arts, as defined by

Georgia Law

§40-2-74, as amended, and his/her signature must be notarized. In addition to signing, the

notary public must affix his/her notary seal or stamp and enter the date his/her notary commission expires.

This application can be electronically completed and printed from our web site, , for signing,

notarization and submission to your County Tag Agent.

Form Mv-90 - Disabled Person'S Parking Affidavit Page 2

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