Disabled Veteran Certification For Va Plates Page 2
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1
2JESSE WHITE
Secretary of State • State of Illinois
PART 3: Medical Eligibility for Meter-Exempt Parking and Physician’s Certification
The meter-exempt parking certification must be completed only when the applicant qualifies for meter-exempt parking. To qual-
ify, the applicant must have a valid Illinois driver’s license, have an ambulatory disability described in Part 2 and also have one of
the following conditions listed below. Economic need is not a consideration for meter-exempt parking.
I hereby certify ________________________________ (Name of Person with Disability) ___________________________(Illinois
Driver’s License of Person with Disability) as listed in Part 1 of this application is also eligible for meter-exempt parking as provided
by statute due to the following PERMANENT medical condition or disability:
Check all that apply:
____ The patient cannot manage, manipulate, or insert coins, or obtain tickets or tokens in parking meters or ticket machines in
parking lots due to the lack of fine motor control of BOTH hands.
____ The patient cannot reach above his/her head to a height of 42 inches from the ground due to a lack of finger, hand or upper-
extremity strength or mobility.
____ The patient cannot approach a parking meter due to his/her use of a wheelchair or other device for mobility.
____ The patient cannot walk more than 20 feet due to an orthopedic, neurological, cardiovascular or lung condition in which the
degree of debilitation is so severe that it almost completely impedes the ability to walk.
__________________________________________________
__________________________________________________
Signature of Physician
Today’s Date
Advanced Practice Nurse/Physician’s Assistant
___________________________________________________________
___________________________________________________________
Name of Collaborating/Supervising Physician
Supervising Physician’s State Medical License #
(if signed above by Advanced Practice Nurse or Physician’s Assistant)
FOR OFFICE USE ONLY
Parking Placard Number: ______________________________________
Expiration Date: _____________________________________________
Issued By: __________________________________________________
Issue Date: _________________________________________________
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