Form PS-15 template
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Seatbelt Exemption Placard Application
This document is an application for a seat belt exemption from the Maine Bureau of Motor Vehicles. The applicant fills out their personal information and provides a statement from a physician justifying the need for the exemption due to a medical condition. The placard issued expires when the physician's certificate does, which may not exceed one year. The form includes fields for placard number, issue date, expiration date, and replacements or returns.
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