Black Brook, NY · Clinton County
Parking Permit or License Plates Application for Persons With Severe Disabilities
This application is for people with severe disabilities who seek a parking permit or disability license plates and submit it to the appropriate issuing agent or motor vehicle office.
What this form is
The application requests a parking permit or license plates for a person with a severe disability that affects mobility. For a parking permit, complete Part 1 and take the application to the appointed issuing agent for the city, town, or village where you live; the form says to contact your local hall to find the nearest agent. It asks for applicant details, the requested permit or plates, and disability information and medical certification.
Who needs it
A person with a severe mobility-related disability who is applying for a parking permit or disability license plates needs this application.
How to submit it
For a parking permit, take the completed application to the appointed issuing agent for the city, town, or village where you live; call your local hall to find the nearest agent. Do not send a parking permit application to the Department of Motor Vehicles.
About notarization
This document is signed without a notary; the applicant signs and dates it, and a medical professional completes and signs the medical certification when required.
How to submit this form
- 1
Download The Application
Download the parking permit or license plates application PDF.
- 2
Complete Part 1
Enter the applicant's information and indicate whether you are applying for a permit or license plates.
- 3
Complete Medical Certification
Have a medical professional complete the applicable certification section when required by the form.
- 4
Submit To The Issuing Agent
For a parking permit, take the completed application to the appointed local issuing agent; call your local hall to find the nearest agent.
Frequently asked questions
- Do I need a notary for the disability parking permit application?
- No. The application has no notary requirement; the applicant signs and dates it, and a medical professional completes and signs the medical certification when required.
- How do I submit the parking permit application?
- Take the completed application to the appointed issuing agent for the city, town, or village where you live. The form says to call your local hall to find the nearest agent.
- Who can apply for a parking permit?
- The form says a resident with one or more severe disabilities that impair mobility may be eligible. The applicant does not have to be a driver or vehicle owner.
- Is medical certification required?
- The form describes medical certification for permanent and temporary disabilities. It also notes that an issuing agent may waive certification in certain cases involving a permanent disability.