Pine Plains, NY · Dutchess County
Application for a Parking Permit or License Plates for Persons With Severe Disabilities
This application lets a person with a severe disability request a parking permit or license plates, with medical certification of the disability.
What this form is
This application is for a person with a severe disability seeking a parking permit or license plates. It asks for the applicant’s contact and identifying information, the type of permit requested, and a medical professional’s certification of the disability and its effect on mobility. Parking permit applicants take the completed application to the issuing agent for the city, town, or village where they live.
Who needs it
A person with a severe disability seeking a parking permit or license plates, or their parent or guardian, completes the applicant section and obtains medical certification.
How to submit it
Take the completed application to the issuing agent for the city, town, or village where you live. Bring your New York State driver license or non-driver ID card if you have one.
About notarization
This application is signed and dated without a notary; the applicant or parent or guardian and medical professional sign and date it.
How to submit this form
- 1
Download The Application
Download the application PDF.
- 2
Complete The Applicant Section
Print and complete the applicant information, indicate whether you are applying for a parking permit or license plates, and sign and date the form.
- 3
Obtain Medical Certification
Have an eligible medical professional complete and sign the medical certification section.
- 4
Submit The Application
For a parking permit, take the completed application to the issuing agent for the city, town, or village where you live.
Frequently asked questions
- Do I need a notary for the disability parking permit application?
- No. This application is signed and dated without a notary; the applicant or parent or guardian and medical professional sign and date it.
- How do I submit the parking permit application?
- Take the completed application to the issuing agent for the city, town, or village where you live. Bring your New York State driver license or non-driver ID card if you have one.
- Who completes the medical certification?
- A medical professional completes and signs the medical certification. The form identifies different eligible professionals for permanent and temporary disabilities.
- Can I use this application for license plates?
- Yes. The form offers an option for license plates, which it says to apply for through the Department of Motor Vehicles.
Need something notarized?
This Application for a Parking Permit or License Plates for Persons With Severe Disabilities doesn’t need a notary — but if you have another Pine Plains form that does, a commissioned online notary can help.