Bergen, NY · Genesee County
Application for a Parking Permit or License Plates for Persons With Severe Disabilities
This application is for people with severe disabilities seeking a parking permit or disability license plates, with a medical professional completing the applicable certification.
What this form is
Use this application to request a parking permit from the local issuing agent where you live or license plates through a Motor Vehicles office. It asks for the applicant’s contact and identifying information, disability details, and—when required—a medical professional’s certification. Permit applicants with temporary disabilities need a medical certification; the instructions also describe when permanent-disability certification may be waived.
Who needs it
A person with a mobility-limiting severe disability may use this application to request a parking permit or, for a permanent 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. For license plates, bring the completed application to any Motor Vehicles office.
About notarization
This document is signed without a notary; the applicant signs Part 1 and a medical professional completes and signs Part 2 when certification is required.
How to submit this form
- 1
Download The Application
Download the four-page application packet and read pages 1 and 2 before completing the application on page 3.
- 2
Complete Part 1
Fill in the applicant’s information, disability details, and whether you are applying for a parking permit or license plates.
- 3
Get Medical Certification
Have a qualified medical professional complete Part 2 when certification is required for your disability.
- 4
Submit The Application
Take a parking permit application to the appointed local issuing agent; bring a license plate application to any 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 signs Part 1, and a medical professional completes and signs Part 2 when certification is required.
- How do I submit the severe-disability parking application?
- For a parking permit, take the completed application to the appointed issuing agent for the city, town, or village where you live. For license plates, bring it to any Motor Vehicles office.
- Who can apply for a parking permit or disability license plates?
- The application is for people with severe disabilities that impair mobility. License plates require a permanent disability, and the vehicle must be registered to the person with the disability.
- Does a parking permit applicant need medical certification?
- The application describes medical certification for permanent and temporary disabilities. It also explains circumstances in which certification for a permanent disability may be waived.