Form PS-15 template
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Seatbelt Exemption Placard Application
The Maine Bureau of Motor Vehicles provides an application for seat belt exemption. Applicants must provide their name, address, daytime phone number, date of birth, and a statement from their physician. The physician's statement includes the patient's medical condition, why wearing a seatbelt is a risk, and the physician's printed name, signature, and license number. The form also includes instructions for returning the completed form and contact information for the Bureau of Motor Vehicles.
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