Free MV2172 - Disabled Veteran Parking License Plates Application - Wisconsin

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I would like nonpersonalized VET plates. I would like personalized VET plates. First Choice
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GENERAL INFORMATION




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Only one Disabled Parking Identification Card (DIS ID) may be issued to persons with VET license plates. When using the DIS ID, you MUST keep a copy of this completed application and provide it for inspection upon request by any traffic officer. Make and keep a copy before submitting application to WI DOT. If you currently have 2 Permanent (Blue) DIS ID cards, one must be returned with this application. The Department may cancel a VET license plate which was issued as a result of fraud or error. To legally operate your vehicle, you must display license plates within 2 business days of purchase. If you do not have current plates, apply to a DMV Customer Service Center or an agent authorized by DMV to obtain a temporary plate while your Disabled Veteran plate order is processed. An agent may charge a $3 plate fee and/or may also charge a $5 service fee.

DISABLED VETERAN (VET) LICENSE PLATES USE
A motorist who displays disabled veteran license plates on their vehicle: Is exempt from any parking ordinance imposing time limits of one-half hour or more, but is otherwise subject to the laws relating to parking; Can park at a municipally-owned/leased lot without payment in metered spaces when the time limit is one-half hour or more; May park in spaces marked by official traffic signs reserving the space for vehicles displaying VET or DIS plates or DIS ID cards; May obtain, upon request, motor fuel from a full-service pump at the same price as fuel from a self-service pump, if the driver is the person with the disability. This applies at locations where fuel is sold at retail from both full and self-service pumps. The retailer is not required to provide any other service that is not provided to customers who use a self-service pump.

U.S. Veteran
Disabled Parking
License Plates

Information
and
Application

Wisconsin Department of Transportation
MV2172 8/2008


QUALIFYING PERSONS
A "Disabled Veteran " license plate may be issued to a military veteran with a permanent disability incurred in active U.S. Military Service that limits or impairs ability to walk, who is the: Owner, Lessee, or Beneficiary of a trust that owns or leases a vehicle.

PERSONALIZING INFORMATION

A V E T
Use capital letters or numbers. The letter O and the number zero are the same. The following are not acceptable: small letters, symbols, signs, hyphens, apostrophes, etc. Carefully distinguish between: Letters L or I and Number 1 Letter S and Number 5 Letter G and Number 6 Letter Z and Number 2 Letter B and Number 8 Letter U and Letter V Provide meaning of request, i.e., what does this represent? Note: If requested personalized plate choices are not available, nonpersonalized VET plates will be issued.







A $15 personalized plate fee is required EACH year in addition to the annual registration fee. No refund or adjustment will be made for a change of choice or spacing after the plate has been ordered, or if the application is incorrectly or unclearly completed. The department may refuse to issue OR may recall after issuance, a request which may be offensive to good taste or decency, misleading or conflict with any other license plates. Allow 4-6 weeks for the manufacturing process, after the Certificate of Registration is issued.

RELEASE OF INFORMATION
The Wisconsin Department of Transportation uses the information on this form to issue disabled parking license cards and plates. Under open records laws, the department must make nonexempt information available upon request. Do you want your name withheld from mailing lists of 10 or more individuals? Yes. This will remove your name from marketing lists.

QUALIFYING VEHICLES
The following vehicles qualify for "Disabled Veteran" license plates: Automobiles Motor homes (Annual registration only); A private truck, dual purpose motor home or dual purpose farm truck which has a gross weight of 8,000 pounds or less; A farm truck which has a gross weight of 12,000 pounds or less.

No.

QUALIFYING DISABILITIES
Any person certified by an authorized VA representative as having a permanent disability resulting from injuries incurred in active U.S. Military service is eligible for the Disabled Veteran Parking License Plates. By legal definition, this includes any person who: Cannot walk 200 feet or more without stopping to rest; Cannot walk without the use of, or assistance from, another person or brace, cane, crutch, prosthetic device, wheelchair or other assistance device; Is restricted by lung disease to the extent that forced expiratory volume for 1 second when measured by spirometry is less than one liter or the arterial oxygen tension is less than 60 mm/hg on room air at rest; Uses portable oxygen; Has a cardiac condition to the extent that functional limitations are classified in severity as class III or IV, according to standards accepted by the American Heart Association; Is severely limited in the ability to walk due to an arthritic, neurological or orthopedic condition.

HOW TO APPLY
1. Complete Applicant Section 2. Have authorized VA representative complete VA Certification 3. If you request a DIS ID card, you MUST keep a copy of this completed application and provide it for inspection upon request by any traffic officer. Make and keep a copy before submitting application to WI DOT. 4. If you want personalized Disabled Veteran (VET) plates, mark application and refer to back side of Applicant Section. If you want nonpersonalized VET plates, mark application. 5. If the vehicle that you wish to register with VET plates is already titled in your name, send: A copy of your Certificate of Registration OR the complete vehicle description on the application; The annual registration fee if the current plates expire within the next 3 months. An additional $15.00 if applying for
personalized plates.
6. If the vehicle is NOT titled in your name, send: A completed title application (MV1 or MV11); All required fees, including annual
registration fee;
An additional $15.00 if applying for
personalized plates.
7. Make check or money order payable to: Registration Fee Trust. 8. Mail this application with payment to: Wisconsin Department of Transportation Special Plates Unit - VET P O Box 7306 Madison WI 53707-7306

Disabled Veteran Parking License Plates Application
MV2172 8/2008 s.341.14(1) Wis. Stats.

Give information for the vehicle that you wish to register with VET plates.
Current License Plate Number

APPLICANT SECTION
Check if you would also like 1 Disabled Parking Identification Card. Registration For Vehicle Owned OR Leased By Check one: Veteran with qualifying physical disability incurred in active U.S. Military Service. Trust whose beneficiary is veteran with qualifying disability incurred in active U.S. Military service. Complete and attach form MV2790.

Vehicle Year - Make

Body Type

Vehicle Identification Number

U.S. Military Service Number

Claim Number

Service Branch

Army Air Force Marines

Navy Coast Guard

Please Print Clearly
Legal Name of Veteran with Disability - First, Middle Initial, Last

VA CERTIFICATION
This must be completed and signed by an authorized representative of the U.S. Department of Veterans Affairs. (A County Veterans Service Officer does not qualify.) This information is privileged and will not be released without written consent of the veteran. This statement is for issuance of disabled parking license plates and is not to be considered as a claim for VA benefits. With the permission of the named applicant, the Department of Veterans Affairs submits the following information concerning his/her service connected disabilities. If you feel the applicant's medical condition or disability may prevent them from exercising reasonable control over a motor vehicle, please contact the Medical Review Unit at (608) 266-2327 or refer to http://www.dot.wisconsin.gov/drivers/ drivers/aging/impaired.htm, for the reporting process.

Address

City, State, ZIP Code

Social Security Number - Used for identification purposes

Month, Day, Year You Were Born

Driver License/Nondriver Identification Number - If none, write NONE

If you have questions about Disabled Veteran parking license plates: Call: 608-266-3041 FAX: 608-267-5106 E-mail: [email protected] Write to the address shown above.

Telephone Number Where You May be Reached 7 a.m. - 4:30 p.m.

AMERICANS WITH DISABILITIES ACT
The Wisconsin Department of Transportation complies with the Americans with Disabilities Act.

I have read the information on this form and under stand the qualifications and provisions under which "Disabled Veteran " license plates may be issued. I authorize the U.S. Department of Veterans Affairs to send a copy of my rating decision to the Wisconsin Department of Transportation.

X (VA Regional Center Authorized Representative)
or (Medical Provider at VA Medical Facility)

(Date)

X
(Signature of Veteran with Disability) (Date)

Note: Recertification is required every 4 years.
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