Contents
Form Example
Application for Persons with Disabilities Parking Placard and/or License Plate
County Use Only
License No
Parking Placard 1
Parking Placard
County No
Date Issued
Instructions
Persons with Disabilities Parking Placard: Submit the completed application and payment (if required) in the form of a personal check, money order, or cashier’s check with proof of eligibility to your local county tax
Persons with Disabilities License Plate: Submit the completed application and payment (if required) in the form of a personal check, money order, or cashier’s check with proof of eligibility to your local county tax
Contact the appropriate local county tax
IMPORTANT: The signature of a licensed medical professional must be notarized on page 2 if an original prescription is not submitted. Otherwise an original prescription must include the disabled person's name, the signature of the licensed medical professional (as defined on page 2), and a statement if the disability is permanent or temporary.
•A parking placard may be issued to persons with a permanent or temporary disability. There is no fee for a placard issued to a person with a permanent disability, and a $5 fee (per placard) if issued to a person with a temporary disability.
•Disabled Person license plates displaying the International Symbol of Access (ISA) may be issued to persons with a permanent disability (limit one set of plates).
•Limit one (1) placard for persons with Disabled Person license plates. Limit two (2) placards for persons with no Disabled Person license plates.
•Attach a separate application if an additional set of Disabled Person plates is needed for certain specially equipped vehicle(s) with gross weight of 18,000 lbs. or less.
•Active duty U.S. military may list an out of state Driver License (DL) or military ID number.
•
Applicant Information
First Name
Middle Name
Last Name
Suffix
Institution Name (if applicable)
Address |
City |
State |
ZIP |
|
|
|
|
|
Phone Number |
|
Identification Statement – State law makes falsifying information a third degree felony.
Please include your Driver License number (DL #) or Identification Card number (ID #) on this application. The DL or ID # provided on this application will be partially shown on the placard issued. My signature below indicates that I am (check one):
the person with the disability listed above. DL or ID # and state of issuance
making application on behalf of a person with a disability and my vehicle is used to regularly transport the person with the disability. DL or ID # and state of issuance
the administrator or manager of an institution licensed to transport persons with disabilities defined under Transportation Code,
Section 681.0032. DL or ID #. Institutions, facilities, and residential retirement communities licensed under Chapter 242, 246, or 247 of the Health and Safety Code must list a facility ID # issued by the agency:
Application for Parking Placard(s) and/or Disabled Person License Plate(s) – Check one below.
Disabled Person License Plate(s) with no Parking Placard |
One (1) Parking Placard with no Disabled Person License Plate(s) |
Disabled Person License Plate(s) and one (1) Parking Placard Two (2) Parking Placards with no Disabled Person License Plate(s) Vehicle Information for License Plate(s) – Complete only if you are applying for Disabled Person plate(s).
Vehicle Identification Number
Current TX Plate
Year
Make
Vehicle Type |
Passenger Car (up to 18,000 lbs.) |
Truck (up to 18,000 lbs.) |
Motorcycle/Moped |
Certification – State law makes falsifying information a third degree felony.
I meet the eligibility requirements as listed on this application and am providing proof to that effect, or I am making application on behalf of a person with a disability as indicated in the Identification Statement above.
Signature: |
|
|
Date: |
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
Form |
Form available online at www.TxDMV.gov |
Page 1 of 2 |
||||
Application for Persons with Disabilities Parking Placard and/or License Plate
Definitions
Transportation Code, Section 681.001(2) defines a disability as a condition in which a person has:
(a)mobility problems that substantially impair the person's ability to ambulate;
(b)visual acuity of 20/200 or less in the better eye with correcting lenses; or
(c)visual acuity of more than 20/200 but with a limited field of vision in which the widest diameter of the visual field subtends an angle of 20 degrees or less.
Transportation Code, Section 681.001(5) defines a mobility problem as one that substantially impairs a person's ability to ambulate, and the person:
(a)cannot walk 200 feet without stopping to rest;
(b)cannot walk without the use of or assistance from an assistance device, including a brace, cane, crutch, another person or a prosthetic device;
(c)cannot ambulate without a wheelchair or similardevice;
(d)is restricted by lung disease to the extent that the person's forced respiratory expiratory volume for one second, measured by spirometry, is less than one liter, or the arterial oxygen tension is less than 60 millimeters of mercury on room air at rest;
(e)uses portable oxygen;
(f)has a cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association;
(g)is severely limited in the ability to walk because of an arthritic, neurological, or orthopedic condition;
(h)has a disorder of the foot that, in the opinion of a physician licensed to practice medicine in this state or in a state adjacent to this state, limits or impairs the person's ability to walk; or
(i)has another debilitating condition that, in the opinion of a physician licensed to practice medicine in this state or a state adjacent to this state, or authorized by applicable law to practice medicine in a hospital or other health facility of the Veterans Administration, limits or impairs the person's ability to walk.
Disability Statement – This section to be completed by a Licensed Medical Professional.*
*A Licensed Medical Professional is defined as a physician, podiatrist, optometrist, or qualifying physician's assistant or advanced practice nurse as defined in Chapter 301, Occupations Code. At least one of the following conditions must be met:
•Licensed in Texas, Arkansas, Louisiana, New Mexico, or Oklahoma; or
•Must practice medicine in a U.S. military installation based in Texas;or
•Must practice medicine in a hospital or health facility of the U.S. Department of Veterans Affairs.
I certify that |
|
|
has a permanent, or temporary disability as defined above. |
||
|
Printed Name of Person with a Disability or Mobility Problem |
|
|||
|
|
|
|
|
|
|
Printed Name of Licensed Medical Professional |
|
Professional License Number |
Date |
|
|
|
|
|
|
|
|
Signature of Licensed Medical Professional |
|
|
|
|
|
|
|
|
|
|
|
Mailing Address |
City |
State |
ZIP |
|
Notary – This section must be completed by a notary if an original prescription is not submitted.
On this date, |
the above named licensed medical professional |
||
|
Date |
|
Name |
appeared before me so that I could witness his or her signature.
State of, County of
S T A M P |
Notary Public |
|
H E R E |
||
|
||
|
My commission expires |
|
|
Date |
Form |
Form available online at www.TxDMV.gov |
Page 2 of 2 |
More PDF Templates
Subcontractor Prequalification - It serves as both a consent and a record of the vaccination administered.
30 Day Notice - The notice protects both the tenant's and landlord's rights during the move-out process.
Common mistakes
-
Omitting Required Documentation: Many applicants forget to include necessary proof of eligibility, such as a medical prescription or documentation from a licensed medical professional. This can delay the processing of your application.
-
Incorrect Payment Method: Submitting cash instead of a personal check, money order, or cashier’s check is a common mistake. Always follow the specified payment instructions to avoid issues.
-
Missing Signature: Failing to sign the application can lead to automatic rejection. Ensure that you or the authorized person signs the form before submission.
-
Inaccurate Personal Information: Providing incorrect details, such as your name, address, or identification number, can complicate your application. Double-check all information for accuracy.
-
Not Notarizing When Required: If you do not submit an original prescription, the signature of the licensed medical professional must be notarized. Forgetting this step can result in a rejected application.
-
Overlooking Eligibility Limits: Applicants sometimes apply for more placards or plates than allowed. Familiarize yourself with the limits to ensure compliance.
-
Neglecting to Include Identification: When applying by mail, it is essential to include a copy of your photo ID. This step is often overlooked and can hinder the processing of your application.
-
Failing to Check Local Office Requirements: Each county may have specific requirements or additional documentation needed. Always contact your local county tax assessor-collector’s office for guidance.
Key takeaways
Filling out the Texas Parking VTR 214 form can be a straightforward process if you follow these key takeaways:
- Eligibility Requirements: Ensure that you meet the eligibility criteria for a parking placard or license plate, which includes having a permanent or temporary disability.
- Application Submission: Submit the completed application along with payment to your local county tax assessor-collector’s office. You can use a personal check, money order, or cashier’s check.
- Medical Professional Signature: If you do not have an original prescription, a licensed medical professional must notarize their signature on page 2 of the form.
- Proof of Eligibility: Include proof of your disability, such as an original prescription or a completed medical statement from a licensed professional.
- Fees: There is no fee for a placard issued to a person with a permanent disability. A $5 fee applies for a placard for a temporary disability.
- Limitations on Placards: Individuals with Disabled Person license plates are limited to one placard. Those without such plates may receive up to two placards.
- Application for Additional Plates: If you need an additional set of Disabled Person plates for specially equipped vehicles, you must attach a separate application.
- Identification Requirements: If applying by mail, include a copy of your photo identification. Do not send cash through the mail.
- Notary Requirements: If an original prescription is not submitted, the notary section must be completed to validate the licensed medical professional’s signature.
By keeping these points in mind, you can navigate the application process more effectively and ensure that you receive the necessary accommodations for your disability.
Steps to Using Texas Parking Vtr 214
Completing the Texas Parking VTR 214 form is a crucial step in obtaining a parking placard or license plate for individuals with disabilities. Follow these steps carefully to ensure that your application is filled out correctly and submitted in a timely manner.
- Gather Required Information: Collect necessary documents, including proof of eligibility, photo identification, and any medical prescriptions if applicable.
- Fill Out Applicant Information: Provide your first name, middle name, last name, suffix, institution name (if applicable), address, city, state, ZIP code, email, and phone number.
- Identify Yourself: Indicate your relationship to the person with the disability by checking the appropriate box and providing the Driver License (DL) or Identification Card (ID) number.
- Select Application Type: Check the box corresponding to the type of application you are submitting: Disabled Person License Plate(s), Parking Placard, or both.
- Complete Vehicle Information: If applying for Disabled Person plates, fill in the Vehicle Identification Number, current Texas plate number, year, make, and vehicle type.
- Certification: Read the certification statement, then sign and date the application to confirm that you meet the eligibility requirements.
- Medical Professional Section: If required, have a licensed medical professional complete the disability statement, including their signature, printed name, and license number.
- Notary Section: If an original prescription is not submitted, ensure that the licensed medical professional's signature is notarized.
- Prepare for Submission: Include payment in the form of a personal check, money order, or cashier’s check (if applicable) and a copy of your photo ID if applying by mail.
- Submit the Application: Send the completed form and required documents to your local county tax assessor-collector’s office or the office where you seek medical treatment. Do not mail cash.