Walworth, NY · Wayne 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 from a local issuing agent or license plates from a Motor Vehicles office.
What this form is
Use this application to request a parking permit or license plates for a person with a severe disability. The form is for people seeking a permit through the issuing agent in their city, town, or village, or license plates through a Motor Vehicles office. It asks for the applicant’s contact and disability information, a choice of permit or plates, and medical certification when required.
Who needs it
A person with a severe disability who is applying for a parking permit or disability license plates needs to complete 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 hall to find the nearest agent. For license plates, bring it to a Motor Vehicles office.
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 page 3.
- 2
Complete Part 1
Enter the applicant’s information, choose a parking permit or license plates, and sign and date Part 1.
- 3
Gather Required Information
For a permit or plates, complete the applicable medical certification in Part 2 unless the stated exception applies.
- 4
Submit the Application
Take a permit application to the appointed local issuing agent, or bring a license-plate application 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 form does not call for notarization.
- How do I submit the parking permit application?
- Take the completed application to the appointed issuing agent in the city, town, or village where you live. Call your local hall to find the nearest agent.
- Can I use this application to request license plates?
- Yes. The form includes an option for license plates. Bring the completed application to a Motor Vehicles office; the vehicle must be registered to the person with the 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 Walworth form that does, a commissioned online notary can help.