Allentown, MT · Monmouth County
Application for Temporary Placard
Applicants use this form to request or recertify a temporary placard, with a medical practitioner certifying their temporary mobility limitation.
What this form is
This application is for an initial temporary placard request or recertification. It asks for applicant details and a medical practitioner’s contact information and certification that the applicant meets the stated eligibility criteria. The applicant agrees to the terms by signing and dating the form; the form also includes a $4 fee payable to NJ MVC and fields for police chief use.
Who needs it
A person seeking an initial temporary placard or recertification, with certification from a medical practitioner, uses this application.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the practitioner certifies eligibility under penalty of law, and the applicant signs and dates the application.
How to submit this form
- 1
Download the Application
Download the Temporary Placard Application PDF.
- 2
Complete Applicant Information
Fill in the applicant information and select initial application or recertification.
- 3
Obtain Medical Certification
Have a medical practitioner complete the certification section and sign and date it.
- 4
Sign and Submit
Sign and date the application, then submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- Do I need a notary for the Temporary Placard Application?
- No. This document is signed without a notary; the medical practitioner certifies eligibility under penalty of law, and the applicant signs and dates the application.
- Who completes the Temporary Placard Application?
- The applicant provides personal information, and a medical practitioner completes the certification section. The form also has fields for police chief use.
- How do I submit the Temporary Placard Application?
- Submit it to the city department named on the form; check the city website for current contact details.
- What does the form say about the fee and recertification?
- The form lists a $4 fee payable to NJ MVC. It states that a temporary placard is valid for no longer than six months and can be recertified once.