Form Mvr-37 - Application For Handicap Driver Registration Plate printable pdf download

MVR-37 (Rev. 06/16)

Do not write in this space

NORTH CAROLINA

DIVISION OF MOTOR VEHICLES

3148 Mail Service Center

Raleigh, NC 27699-3148

APPLICATION FOR HANDICAPPED DRIVERS REGISTRATION PLATE

VEHICLE SECTION

YEAR

MAKE

BODY STYLE

SERIES MODEL

VEHICLE IDENTIFICATION NUMBER

OWNER SECTION

_______________

__________________________________________________________

Owner ID Number

Full Legal Name of Owner (First, Middle, Last, Suffix) or Company Name

Residence Address (Individual) Business Address (Firm)

City and State

Mail Address (if different from above)

I certify for the motor vehicle described above that I have financial responsibility as required by law.

____________________________________

_____________________________________

Insurance company authorized in NC

Policy Number

(This application must be signed by your

physician)

((This application must be signed by your physician

)

Year __________

G.S. 20-37.5 Handicapped—definitions and parking privileges. (1) “Handicapped” shall mean a person with a mobility impairment who,

as determined by a licensed physician; (a) Cannot walk 200 feet without stopping to rest; (b) Cannot walk without the use of, or assistance

from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device; (c) Is restricted by lung disease to such

an extent that the person’s forced (respiratory) expiratory volume of one second, when measured by spirometry, is less than one liter, or the

arterial oxygen tension is less than 60 mm/hg on room air at rest; (d) Uses portable oxygen; (e) Has a cardiac condition to the extent that the

person’s functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Associat-

ion; (f) Is severely limited in their ability to walk due to an arthritic, neurological, or orthopedic condition; or (g) Is totally blind or whose

vision with glasses is so defective as to prevent the performance of ordinary activity for which eyesight is essential, as certified by a licensed

ophthalmologist, optometrist, or the Division of Services for the Blind. Any person who falls within the definition of handicapped shall be

allowed to park for unlimited periods in parking zones restricted as to length of time parking is permitted. This provision has no application

to those zones or during times in which the stopping, parking, or standing of all vehicles is prohibited or which are reserved for special types

of vehicles. As a condition to this privilege the vehicle shall display a distinguishing license plate or removable windshield placard.

I hereby apply for a handicapped drivers’ registration plate under the above statutory provisions and certify that my physical condition

entitles me to the issuance thereof.

____________________________________________________________

(Applicant’s Signature)

(Date)

I hereby certify that the physical condition of the above named applicant constitutes the applicant a handicapped driver as defined under

statutory provision G S. 20-37.5 and G.S. 20-37.6.

________________________________________________

____________________________________________

(Physician’s Signature)

(Physician’s Printed Name)

(Date)

__________________________________________________________

_____________________________________________________

(Physician’s Address)

(Physician’s Telephone Number)

FEE: REGULAR REGISTRATION PLATE FEE

Form Mvr-37 - Application For Handicap Driver Registration Plate

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