Declaration Of Handicapped Placard Authorization - Las Vegas
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1City of Las Vegas
Parking Services Office
500 S Main Street
Las Vegas, NV 89101
Tel: (702) 229-4700
Fax: (702) 382-2309
DECLARATION OF HANDICAPPED PLACARD AUTHORIZATION
LVMC 11.52.135 Handicapped Parking
A person shall not park a vehicle in a space designated for the handicapped by a sign that meets the requirements of Subsection
(A), whether on public or privately owned property, unless he is eligible to do so and the vehicle displays: (1) A special license
plate or plates issued pursuant to NRS 482.384(2) A special or temporary parking placard issued pursuant to NRS 482.384 (3) A
special or temporary parking sticker issued pursuant to NRS 482.384;(4) A special license plate or plates, a special or temporary
parking sticker, or a special or temporary parking placard displaying the international symbol of access issued by another state or
foreign country; or(5) A special license plate or plates for a disabled veteran issued pursuant to NRS 482.377.
PLEASE PRINT LEGIBLY
I,
, currently residing at
(Placard Owner)
____________
declare that on the day and time
(Placard Owner’s Complete Address)
the citation listed below was issued, I was being transported by:
_________________
.
(Vehicle’s Registered Owner)
I declare that I am the authorized person the below listed handicapped placard is issued to by the
Department of Motor Vehicles.
Handicap Placard Owner Information
**
Handicap Placard Number: _________
_Handicap Placard State:
** If state is other than NV, must include DMV issuance letter showing placard# and placard holders name.
Handicap Placard Owner’s Date of Birth:
Driver’s License Number
____
Handicap Placard Expiration Date:
Citation Information
Citation Number:
_______
License Plate Number:
_______
____________________________________________________________________________________
** I declare under the penalty of perjury, that the above information is complete, true and accurate.
SIGNATURE OF PLACARD OWNER
DATE
PRINT NAME
TELEPHONE NUMBER
Form revised 04-01-2016
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