Adot Form 96-0104

Adot Form 96-0104 - A completed Disability Hearing Impaired Plate Placard Application Form 96 0104 Medical certification ON the application completed by a licensed physician osteopath or chiropractor Payment for applicable fees Placards Free License plates Free Personalized plates 26 96

Must complete application form 96 0104 signed by a physician or hospital administrator

Adot Form 96-0104

Adot Form 96-0104

Disability plates may be personalized for an additional fee of $25 per year for standard personalized plates or $50 per year for specialty personalized plates. A Special Plate Application (form # 96-0143, available online) must be completed for a personalized plate. All choices must be approved.

96 0104 R02 23 azdot gov Mail Drop 801Z Special Plates Unit Motor Vehicle PO Box 2100 Division Phoenix AZ 85001 2100 For eligibility INDIVIDUAL DISABILITY DEAF HARD OF HEARING PLATE PLACARD APPLICATION and additional information see reverse side APPLYING FOR check only one Placard Both Replacement Medical certification not

Disability Full Size 6 Quot X 12 Quot Department Of Transportation ADOT

96 0104 Purpose To apply for a disability plate or placard both permanent and temporary to add a disability symbol to a special license plate or for a hearing impaired license plate or placard

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Disability plates may be personalized for an additional fee of 25 per year for standard personalized plates or 50 per year for specialty personalized plates A Special Plate Application form 96 0143 available online must be completed for a personalized plate All choices are subject to approval

Disability License Plates Amp Placards In Arizona DMV ORG

Step 1 Form 96 0104 Download and print form 96 0104 from the Arizona Department of Motor Vehicles website Form 96 0104 is the application for a handicapped license plate rear view mirror hanger also called a placard Step 2 A Doctor s Signature

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96 0104B R02 23 azdot gov Mail Drop 801Z Special Plates Unit Motor Vehicle Division PO Box 2100 Phoenix AZ 85001 2100 ORGANIZATION DISABILITY PLATE PLACARD APPLICATION Application Type New Plate postage fee is 1 96 New Placard Replacement Placard For eligibility see reverse side of the application

The applicant must file a Disability-Hearing Impaired Plate/Placard Application form ( Form 96-0104 ). The application form can be obtained online. Fee According to § 28-2409, the transportation department shall issue placards at no additional charge. Validity/expiration of placards/permits

Disability Hearing Impaired Plate Placard Application

Visit website for application form 96 0104 Must be signed by an Arizona physician registered nurse nurse practitioner audiologist or hospital administrator Visit any MVD office or authorized third party office or write to request disability plates and placards Description

Adot Form 96-0104

96 0104B R02 23 azdot gov Mail Drop 801Z Special Plates Unit Motor Vehicle Division PO Box 2100 Phoenix AZ 85001 2100 ORGANIZATION DISABILITY PLATE PLACARD APPLICATION Application Type New Plate postage fee is 1 96 New Placard Replacement Placard For eligibility see reverse side of the application

Must complete application form 96 0104 signed by a physician or hospital administrator

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