Fillable Printable Application For A Handicapped Personalized License Plate
Fillable Printable Application For A Handicapped Personalized License Plate
Application For A Handicapped Personalized License Plate
NORTH CAROLINA DIVISION OF MOTOR VEHICLES
3155 Mail Service Center
Raleigh, North Carolina 27699-3155
APPLICATION FOR A HANDICAPPED PERSONALIZED LICENSE PLATE
The $30.00 personalized fee is an (ANNUAL) fee due in addition to the regular license fee.
Remit a $30.00 check or money order with this application
-
Annual Fee G.S. 20-79.7
use 1 to 6 spaces
SHOW CHOICES 1.__ __ __ __ __ __ 3.__ __ __ __ __ __ 5.__ __ __ __ __ __
IN ORDER OF PREFERENCE
2.__ __ __ __ __ __ 4.__ __ __ __ __ __ 6.__ __ __ __ __ __
Your personalized plate choice may be selected from letter, number and character combinations not
exceeding six spaces. See chart below for assistance.
THIS APPLICATION MUST BE SIGNED BY YOU AND YOUR PHYSICIAN
G.S. 20-37.5 HANDICAPPED
-
definitions.
-
As used in this Article, handicapped shall mean: (1 ) any person who has an obvious physical dis-
ability that requires the use of a wheelchair, braces, walkers, or crutches, and those who have lost the use of one or both legs; or (2) any per-
son who, as determined and certified by a physician, is severely restricted in mobility by a pulmonary or cardiovascular disability, arthritic
condition, orthopedic or neurologic impairment; or (3) any person who is visually impaired as defined by G.S. 111-11, and certified by a
licensed opthalmologist, optometrist, or the Division of Services for the Blind. Any person who falls within these definitions of handicapped
shall be allowed to park for unlimited periods in parking zones restricted as to the length of time parking is permitted. This section shall have
no application to those zones or during times in which the stopping, parking or standing of all vehicles is prohibited or which are reserved
for special types of vehicles. (G.S. 20-37.6)
I hereby apply for a handicapped personalized license plate under the above statutory provisions and certify that my physical condition enti-
tles me to the issuance thereof.
________________________________________________________
(APPLICANT’S SIGNATURE) (DATE)
I hereby certify that the physical condition of the above named applicant constitutes the applicant a handicapped driver as defined above
under statutory provisions G.S. 20-37.5 and G.S. 20-37.6.
________________________________________________________
(PHYSICIAN’S SIGNATURE) (DATE)
(These plates are issued from Raleigh Office only)
NAME (To agree with certificate of title)
FIRST MIDDLE LAST
ADDRESS
CITY STATE ZIP CODE
Current North Carolina
PLATE NUMBER VEHICLE IDENTIFICATION NUMBER
DRIVER LICENSE # YEAR MODEL MAKE BODY STYLE
MVR-27H
(Rev. 12/03)
Ampersand (&) counts as one space
Number Sign (#) counts as one space
Period ( ) counts as 1/2 space
Colon (:) counts as 1/2 space
Double Quotes (
“ ”
) counts as two
spaces
Single Quote (
‘ ’
) counts as one space
Apostrophe (I) counts as 1/2 space
Dash (
-
) counts as 1/2 space
Question mark (?) counts as one space
Comma (,) counts as 1/2 space
Exclamation Point (!) counts as 1/2 space
At Sign (@) counts as one space
Plus Sign (+) counts as one space
Dollar Sign ($) counts as one space
Slant Line (/) counts as one space
Equal Sign (=) counts as one space
Asterisk (*) counts as one space
Home
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AREA CODE–TELEPHONE NUMBER
Office
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AREA CODE–TELEPHONE NUMBER
