This form grants a waiver from the photo identification requirement for a person with a disability to access reserved parking spaces. The waiver applies if the person is a resident of a licensed facility providing long-term medical or personal care, or lives at home with a caregiver. To apply for or renew a special plate or certificate for reserved parking, the applicant must submit this completed form and a Doctor's Certification for first-time applications. For facility residents, the administrator completes the form with the name of the facility, address, city, state, ZIP, and federal employer ID number. Home care providers or persons with disabilities complete it with their printed names, signatures, dates, and relevant identification numbers.
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