Holland, NY · Erie County
Application for a Parking Permit or License Plates for Persons With Severe Disabilities
This application is for a person with a severe disability seeking a parking permit or license plates, with medical certification completed when required.
What this form is
The application is used to request a parking permit or license plates for a person with a severe disability. Applicants complete Part 1, and a qualified medical professional completes Part 2 when medical certification is required; the form describes separate eligibility and certification rules for temporary and permanent disabilities. Parking permit applications go to the issuing agent for the applicant’s city, town, or village, not to the Department of Motor Vehicles.
Who needs it
A person with a severe disability, or their parent or guardian, needs this application to request a parking permit or disability license plates.
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. The instructions say to call your local city, town, or village hall to find the nearest agent.
About notarization
This document is signed without a notary; the applicant and medical professional sign and date their respective sections.
How to submit this form
- 1
Download The Application
Download the application and read pages 1 and 2 before completing the form on page 3.
- 2
Complete Part 1
Print the applicant’s information, select whether you are applying for a permit or plates, and sign and date Part 1.
- 3
Complete Medical Certification
Have a qualified medical professional complete Part 2 when medical certification is required.
- 4
Submit To The Appropriate Office
For a permit, take the application to the appointed local issuing agent. For license plates, bring it to a Motor Vehicles office.
Frequently asked questions
- Do I need a notary for the severe disability parking application?
- No. This document is signed without a notary; the applicant and medical professional sign and date their respective sections.
- How do I submit a parking permit application?
- Take the completed application to the appointed issuing agent for the city, town, or village where you live. The instructions say to call your local hall to find the nearest agent.
- Who can apply for a parking permit?
- The instructions say a New York State resident with one or more severe disabilities that impair mobility may be eligible. The permit is issued in the name of the person with the disability.
- Can I use this application to request license plates?
- Yes. The application covers parking permits and license plates. The instructions say license plate applications go to a Motor Vehicles office and require a permanent disability.
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 Holland form that does, a commissioned online notary can help.