Form RDMV130 template
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Walking Disability Privileges
The document is an application form for Walking Disability Privileges issued by the Department of Safety, Division of Motor Vehicles in New Hampshire. The form includes three sections: I. Applicant’s Information, II. Medical Provider Information, and III. Frequently Asked Questions. Section I requires the applicant's personal information, including name, date of birth, mailing address, driver license number or ID number (if applicable), selection of privileges, and signature. Section II requires certification from a medical provider regarding the applicant's walking disability based on specific criteria. Section III includes FAQs about the application process, renewals, use of placards, and replacement of lost or stolen placards.
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