DeRuyter, NY · Madison 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 and is completed by the applicant and a medical professional.
At a glance
- Issued by
- City of DeRuyter · DeRuyter, Madison County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- deruyter.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a parking permit or license plates for a person with a severe disability. The applicant completes Part 1, and a qualified medical professional generally completes the medical certification in Part 2; the instructions describe exceptions for some permanent disabilities. The form asks for the applicant’s contact and identifying information, disability details, and medical certification. Permit applicants take it to their local issuing agent; plate applicants apply through a Motor Vehicles office.
Who needs it
A person with a severe disability seeking a parking permit or disability license plates, or a parent or guardian applying on that person’s behalf, needs this application.
How to submit it
For a parking permit, take the completed application to the appointed issuing agent in the city, town, or village where you live; call your local city, town, or village hall to locate an agent. For license plates, bring the completed application to any Motor Vehicles office.
About notarization
This document is signed and dated without a notary; the applicant and medical professional sign their respective sections, and no notarized attachment is specified.
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 Part 1.
- 3
Get Medical Certification
Have a qualified medical professional complete Part 2 when required for the requested permit or plates.
- 4
Submit the Application
For a permit, take it to the local issuing agent. For plates, bring it to a Motor Vehicles office.
Frequently asked questions
- Do I need a notary for the severe-disability parking application?
- No. The applicant and medical professional sign and date their sections; the document does not require a notary or specify a notarized attachment.
- How do I submit a parking permit application in DeRuyter?
- Take the completed application to the appointed issuing agent in the city, town, or village where you live. The instructions say to contact your local hall to find an agent.
- Who completes the medical certification?
- A qualified medical professional completes Part 2. The form lists eligible professionals and says temporary disabilities may be certified only by a Medical Doctor or Doctor of Osteopathy.
- Can I use this application to request license plates?
- Yes. The form covers both parking permits and license plates. For plates, the disability must be permanent, and the vehicle must be registered to the person with the disability.