Freehold Township, MT · Monmouth County
Application for Temporary Placard
Applicants seeking a temporary placard complete this application with personal information and a medical practitioner’s certification.
What this form is
This application is for an initial temporary placard or recertification. It asks for the applicant’s personal and driver information, a medical practitioner’s contact details and certification, and the applicant’s agreement to the terms. The form states that a $4.00 fee payable to the NJ MVC must be attached and that a temporary placard is valid for no longer than six months.
Who needs it
A person seeking an initial temporary placard or recertification needs this application and a medical practitioner’s certification of eligibility.
How to submit it
The form lists the Special Plate Unit, P.O. Box 015, Trenton, New Jersey 08666-0015, and a $4.00 fee payable to NJ MVC. It does not explicitly state submission instructions.
About notarization
This document is signed without a notary; the medical practitioner certifies the applicant’s eligibility under penalty of law, and the applicant signs and dates the terms.
How to submit this form
- 1
Download The Application
Download the Application for Temporary Placard.
- 2
Complete Applicant Information
Fill in the applicant information and select initial application or recertification.
- 3
Get Medical Certification
Have a medical practitioner complete the certification section and sign and date it.
- 4
Sign And Submit
Sign and date the terms, attach the $4.00 fee payable to NJ MVC, and use the Special Plate Unit address listed on the form.
Frequently asked questions
- Do I need a notary for the Application for Temporary Placard?
- No. The form has signature lines for the applicant and medical practitioner, but no notary block. The practitioner certifies eligibility under penalty of law.
- How do I submit the temporary placard application?
- The form lists the Special Plate Unit, P.O. Box 015, Trenton, New Jersey 08666-0015, and says to attach a $4.00 fee payable to NJ MVC.
- What information does the application request?
- It requests applicant and driver information, the medical practitioner’s contact details and certification, and the applicant’s signature agreeing to the terms.
- Can I use this application for recertification?
- Yes. The form has options for an initial application and recertification, and states that recertification requires a qualified medical practitioner.
Need something notarized?
This Application for Temporary Placard doesn’t need a notary — but if you have another Freehold Township form that does, a commissioned online notary can help.