Bergen, NY · Genesee County
Parking Permit Application for Persons With Severe Disabilities
New York residents with severe disabilities use this application to request a parking permit or license plates, with medical certification when required.
What this form is
The application requests a parking permit or license plates for a person with a severe disability that impairs mobility. For a parking permit, the applicant takes the completed form to the issuing agent for the municipality where they live; the form says to contact the local hall to find the nearest agent. It asks for the applicant’s identifying information and request, and includes medical certification and issuing-agent sections.
Who needs it
A person with a severe disability who lives in Bergen and seeks a parking permit should complete this application and take it to the local issuing agent.
How to submit it
Take the completed application to the appointed issuing agent for the city, town, or village where you live. The form advises other New York residents to call their local city, town, or village hall to find an agent.
About notarization
This application is signed and dated without a notary; the medical professional also signs and dates the medical certification, with no notarized or sworn attachment identified.
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
Enter the applicant’s information, select a parking permit or license plates, and sign and date the application.
- 3
Get Medical Certification
When required, have an eligible medical professional complete and sign the medical certification in Part 2.
- 4
Submit to the Local Issuing Agent
Take the completed application to the appointed issuing agent for the municipality where you live.
Frequently asked questions
- Do I need a notary for the Parking Permit Application?
- No. The applicant signs and dates the form, and a medical professional signs and dates the medical certification when required; neither section calls for a notary.
- How do I submit the Parking Permit Application?
- Take the completed application to the appointed issuing agent for the municipality where you live. The form says to contact your local hall to find an agent.
- Who can apply for a disability parking permit?
- The form says New York residents with one or more severe disabilities that impair mobility may be eligible. Children and people who do not drive may also qualify.
- Does the application require medical certification?
- The form includes medical certification for permanent or temporary disabilities. It describes limited exceptions for some permanent disabilities.