STATE OF CALIFORNIA

DEPARTMENT OF MOTOR VEHICLES

®

APPLICATION FOR DISABLED PERSON PLACARD OR PLATES

NOTE: For lost, stolen, or mutilated Disabled Person or Disabled Veteran License Plates or Placard, please complete an Application For Replacement Plates, Stickers, and Documents (REG 156) form, available at www.dmv.ca.gov.
Attention Disabled Veterans with a 100% Disability Rating: You may be eligible for a Disabled Veteran License
Plate, which is exempt from the payment of the registration and license fees. Documentation from the Department of
Veterans Affairs along with DMV form REG 256A is required – see www.dmv.ca.gov or call 1-800-777-0133.

DMV USE ONLY
SECTION(S) A R/O Comm.
(cIRcLE)

NO. VERIFIED BY:
(INITIALS & ID #)

DCS ATTACHED

A. DISABLED PERSON’S INFORMATION (PLEASE PRINT)
TRUE FULL NAME (LAST, FIRST, MIDDLE OR ORGANIZATION NAME)

DATE OF BIRTH (NOT REQUIRED FOR ORGANIZATIONS)

Month
PHYSICAL ADDRESS (INcLUDE ST., AvE., RD., cT., ETc.)

Day

Year

APT./SPACE/STE.#

CITY

STATE

zIP CODE

DRIVER LICENSE/ID CARD NUMBER

MAILING ADDRESS (IF DIFFERENT FROM PHYSIcAL ABOvE) APT./SPACE/STE.#

CITY

STATE

zIP CODE

DAYTIME TELEPHONE NUMBER

(

)

Were you ever issued Disabled Person or Disabled Veteran License Plates or a Permanent Parking Placard in California?
YES – A doctor’s disability certification is NOT required, unless the placard was canceled by DMV or is no longer on record.
.
The Disabled Person or Disabled Veteran License Plates or Placard number is:
NO – A doctor’s certification is required. The doctor must complete Sections F and G on the reverse side.
B. PLEASE CHECK AT LEAST ONE OF THE FOLLOWING BOXES:
Travel Parking Placard
No Fee
Permanent Parking Placard
No Fee
Travel Parking Placards are issued to applicants with permanent disabilities.
Temporary Parking Placard
$6.00
A California resident applying for a Travel Parking Placard must have a
Is this a renewal of a previously issued Temporary Parking
Permanent Parking Placard or Disabled Person or Disabled Veteran License
Placard?
Yes
No. If Yes, enter the number of
Plates, but not both. Travel Parking Placards are issued to non-residents for consecutively issued placards to you:
.
no more than 90 days and to California residents for no more than 30 days.
Disabled Person License Plates No Fee (see Section c)
NOTE: Disabled Person License Plates can only be assigned to vehicles currently registered in the name of the qualified disabled person.

C. DISABLED PERSON LICENSE PLATE APPLICANTS – Do NoT comPLETE If APPLyINg foR A PARkINg PLAcARD oNLy.
Please list the vehicle registered to you on which you will place the Disabled Person License Plates:
CURRENT LICENSE PLATE NUMBER

VEHICLE IDENTIFICATION NUMBER

MAkE

COMMERCIAL VEHICLE EXEMPTION
I am requesting an exemption from weight fees for the vehicle described above. It weighs less than 8,001 pounds unladen. I understand that this exemption may be used for ONE commercial vehicle only and I do not have this exemption for any other vehicles I own.
Yes
No
D. IMPORTANT INFORMATION – PLEASE READ
• The only legal use of a placard is its display by the person to whom it is issued. It cannot be loaned to anyone, including family members or friends and a peace officer or parking enforcement person may confiscate a placard being used for parking purposes that benefit a person other than the person to whom the placard was issued. A placard ID card identifying the placard owner is issued with every placard and should be kept with the placard owner at all times whenever the placard is in use, and presented upon request of a peace officer or a person authorized to enforce parking laws, ordinances, or regulations. The disabled person does not have to own or drive the vehicle to use the placard.
• Placard abuse or misuse can result in the confiscation, cancellation, and revocation of the placard and loss of the