
License No
Parking Placard 1
Parking Placard 2
County No
Date Issued
Institution Name (if applicable)
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 Identification Number
Passenger Car (up to 18,000 lbs.) Truck (up to 18,000 lbs.) Motorcycle/Moped
: D
ate:
Application for Persons with
Disabilities Parking Placard
and/or License Plate
County Use Only
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 assessor-collector’s office or the county tax assessor-
collector’s office where you are seeking medical treatment.
IMPORTANT: The signature of a licensed medical professional must be notarized on page 2 if an original prescription is not submitted. 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.
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 assessor-collector’s office.
Contact the appropriate local county tax assessor-collector’s office for processing application by mail. Do not mail cash. Include a copy of
the photo identification (ID) if applying by mail.
• An original prescription is acceptable proof if not providing a written statement or completing the Disability Statement below.
• 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.
Applicant Information
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.
Vehicle Information for License Plate(s) – Complete only if you are applying for Disabled Person plate(s).
Vehicle Type
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
Form VTR-214 Rev. 09/24 Form available online at www.TxDMV.gov Page 1 of 2