Mvr-37
MVR-37 (Rev. 07/17)
NORTH CAROLINA
DIVISION OF MOTOR VEHICLES
3148Mail ServiceCenter
Raleigh, NC 27697-3148
Do
not write in thisspace
APPLICATION FOR HANDICAPPED DRIVERS REGISTRATION PLATE
VEHICLE SECTION
YEAR
MAKE
BODY STYLE
SERIES MODEL
VEHICLE IDENTIFICATION NUMBER
OWNER SECTION
OwnerID Number Full Legal Name of Owner (First, Middle, Last, Suffix) or Company Name
Residence Address (Individual) BusinessAddress (Firm)
City and State
MailAddress (if different from above)
I certify for the motor vehicle described above thatI have financial responsibility as required by law.
Insurance company authorized in NC Policy Number
(This application must be signed by your Medical Provider) Year
G.S. 20-37.5 Handicapped—definitions and parking privileges.(1) “Handicapped” shall mean a person with a mobility impairment who,
as determined by a licensed physician; (a) Cannot walk 200 feet without stopping to rest; (b) Cannot walk without the use of, or assistance
from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device; (c) Is restricted by lung diseaseto such
an extent that the person’s forced (respiratory) expiratory volume of one second, when measured by spirometry, is lessthan one liter, or the
arterial oxygen tension is lessthan 60 mm/hg on room air at rest; (d) Uses portable oxygen; (e) Has a cardiac condition to the extent that the
person’s functional limitations are classified in severity as ClassIII or Class IV according to standards set by the American Heart Associat-
ion; (f) Is severely limitedin their abilityto walkdue to an arthritic, neurological, or orthopediccondition; or (g) Is totally blind or whose
vision with glasses is sodefective as to prevent the performance of ordinaryactivity for which eyesight is essential,as certified by a licensed
ophthalmologist, optometrist, or the Division of Services for the Blind. Any person who falls within thedefinition of handicapped shall be
allowed to park for unlimited periods in parking zones restricted as to length of time parking is permitted. This provision has 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. As a condition to this privilege the vehicle shall display a distinguishing license plate or removable windshield placard.
I hereby apply for a handicapped drivers’registration plateunder the above statutoryprovisions and certify that my physical condition
entitles me to the issuance thereof.
(Applicant’s Signature)(Date)
I hereby certify that the physical condition of the abov e named applicant constitutes the applicant a handicapped driver as defined under
statutoryprovision G S. 20-37.5 and G.S. 20-37.6.
(Medical Provider’s Signature) (Medical Provider’s Pri nted Name)(Date)
_
(MedicalProvider’s Address) (Medical Provider’s Telephone Number)
FEE: REGULAR REGISTRATIONPLATE FEE
