Mv 145A PDF Template

The Mv 145A form is an application for a Person with Disability Parking Placard in Pennsylvania. This form allows eligible individuals to request a parking placard that provides special parking privileges, ensuring easier access to public spaces. If you or someone you know qualifies, take the first step by filling out the form below.

Article Guide

The MV-145A form serves as an essential application for obtaining a parking placard designated for individuals with disabilities in Pennsylvania. This form caters to various needs, including requests for permanent or temporary placards, renewals, and replacements for lost or stolen placards. It also accommodates changes of address or name. To qualify for a placard, applicants must provide personal information, including their name, address, and a certification from a licensed healthcare provider that verifies their disability. The form outlines specific eligibility requirements, such as visual impairments or mobility limitations, ensuring that only those who genuinely need assistance can access these benefits. Additionally, the application process includes sections that allow for certification by a police officer or the U.S. Department of Veterans Affairs, further validating the applicant's condition. It is important to follow the instructions carefully to avoid delays in processing. By ensuring compliance with these guidelines, applicants can secure the necessary accommodations to facilitate their mobility and access to essential services.

Mv 145A Preview

ORIGINAL REQUEST - q Permanent Placard q Severely Disabled Veteran q Temporary Placard

RENEWAL REQUEST - (For Permanent Placards Only)

REPLACEMENT REQUEST -

q PLACARD q ID CARD q Defaced q Lost q Stolen q Never Received PREVIOUS PLACARD # ______________________

CHANGE OF ADDRESS - Complete Sections A and E.

CHANGE OF NAME - Complete Sections A and E. Check here to indicate reason for change of name:

q Marriage q Divorce q Other: ______________________

CHECK ( 4) APPROPRIATE BLOCKS BELOW

PERSON WITH DISABILITY INFORMATION - LIST NAME AND ADDRESS OF PERSON WITH DISABILITY - NOTE: If listing an out-of-state address,

you must also complete and attach Form MV-8.

CERTIFICATION FROM A HEALTH CARE PROVIDER LICENSED OR CERTIFIED IN PA OR A CONTIGUOUS STATE (NEW YORK, NEW JERSEY, DELAWARE, MARYLAND, WEST VIRGINIA OR

OHIO). THIS SECTION MUST BE COMPLETED IN FULL. HEALTH CARE PROVIDERS MAY ONLY CERTIFY DISABILITIES WITHIN THEIR SCOPE OF PRACTICE. WARNING: Altering or forging a

document issued by the Department, such as a disabled person parking placard, or possessing, using or displaying such a document knowing it to have been altered, forged or counterfeited,

is a misdemeanor of the first degree pursuant to the Vehicle Code, 75 Pa.C.S. Section 7122, punishable by a fine of not more than $10,000 or imprisonment of not more than five years, or both.

CERTIFICATION BY POLICE OFFICER - Police officer may only certify that the applicant does not have full use of a leg or both legs, or is blind.

NOTE: If Section B above is completed, please skip this Section and go on to Section E.

UNSWORN DECLARATION AND APPLICANT SIGNATURE - Person with disability, natural parent or other authorized person listed in Section A must sign below.

Last Name (or Full Business Name)

Street Address

City State Zip Code

First Name Middle Name PA DL/Photo ID#

or Bus. ID#

Date of Birth

NOTE: If you are the parent or adult charged by law with the natural parent’s rights, duties and responsibilities acting on behalf of a minor child (under 18) in place of the child’s natural parents (person in

loco-parentis), you must complete the information below. In addition, a parent, including an adoptive or foster parent who has custody care or control of the child or adult child or a spouse may sign on

behalf of the child, adult child or spouse (applicant) provided the applicant meets eligibility requirements (1) through (8).

Name of Parent, Person in Loco Parentis or Spouse

Email Address

Street Address City

State Zip Code

Relationship to Applicant

I hereby certify that the person with the disability listed above is under my care and has the following condition listed on the reverse side of this

application under “Eligibility Requirements”: _______________ (NOTE: Only those conditions listed on the reverse side of this application qualify

an applicant for a person with disability placard.)

NOTE: If reason code #1 is listed above, please indicate the individual's visual acuity by completing the chart to the right:

If reason code #4 is listed above, please indicate the type of device used: ________________________________________________

Temporary placards are only issued for a period of time not to exceed six months. If the applicant requires additional time after the expiration of

the placard issued, the applicant must be recertified by a health care provider.

List Reason Code # Here

Health Care Provider’s Printed Name

Health Care Provider’s Signature

Medical License No.

Officer’s Printed Name

Office Street Address

City

State Zip Code

Officer’s Signature

Badge Number

Telephone Number

( )

This is to certify that the person with disability listed above has the condition listed and is entitled to the use and privileges of the person with disability

parking placard.

is blind,

OR does not have full use of a leg or both legs as evidenced by the use of a:

crutches

wheelchair walker

cane/quad cane other prescribed device

THIS APPLICATION MAY BE DUPLICATED

MV-145A (6-25)

(The space above is for Department use only)

Bureau of Motor Vehicles • P. O . Box 68268 • Harrisburg, PA

17106-8268

CERTIFICATION FROM U.S. DEPARTMENT OF VETERANS AFFAIRS REGIONAL OFFICE ADMINISTRATOR (PHILADELPHIA OR PITTSBURGH)

OR SERVICE UNIT IN WHICH THE VETERAN SERVED OR A LEGIBLE PHOTOCOPY OF THE APPLICANT'S LETTER OF PROMULGATION,

AWARDS LETTER, SINGLE NOTIFICATION, OR SUMMARY OF BENEFITS LETTER.

This is to certify that the veteran listed above with VA number ___________________________, has a 100% service-connected disability or has the

following service connected disability reason code number _______, listed on the reverse side of this application under “Eligibility Requirements.”

NOTE: If reason code #4 is listed, please indicate the type of device used: __________________________.

Authorized Printed Name and Title: ____________________________________________ Authorized Signature: ____________________________________________

In lieu of the U.S. Department of Veterans Affairs Regional Office Administrator certification, I have attached a legible photocopy of my Letter of

Promulgation, Awards Letter, Single Notification Letter, or Summary of Benefits Letter that indicates I have a 100% service-connected disability.

UNCORRECTED

R 20/

L 20/

B 20/

CORRECTED

R 20/

L 20/

B 20/

PERSON WITH DISABILITY PARKING PLACARD APPLICATION

NO FEE REQUIRED

SEE REVERSE SIDE FOR INSTRUCTIONS AND ELIGIBILITY REQUIREMENTS

Office Street Address

City

State Zip Code Telephone Number

( )

I/We declare under penalty of perjury under the law of the Commonwealth of Pennsylvania, that the foregoing is true and correct, and that application was made for the above product or

that the items as indicated were never received in the mail. Furthermore, I/we state that I/we have read and signed this application after its completion, and I/we swear or affirm that the

statements made herein are true and correct, and that any statement made on or pursuant to this application is subject to the penalties of 18 Pa.C.S. Section 4904 (relating to unsworn

falsification), which include criminal prosecution and a term of imprisonment, the maximum of which may be one year [18 Pa.C.S. 4904(b)], or up to two years[18 Pa.C.S. 4904(a)]. In

addition to any other penalty, a person convicted under this section shall be sentenced to pay a fine of at least $1,000 [18 Pa.C.S. 4904(d)].

Signed on the _____ day of _______________, ___________________ at ________________________________________, _________________________.

Person with Disability/Loco Parentis Signature

Telephone Number

Printed Name of Person with Disability

(county or other location, and state) (country)

INSTRUCTIONS

1. Permanent Placard - Complete Sections A, B or C (NOT BOTH) and E. NOTE: Individuals should list their PA Driver’s License (PA DL) or Photo ID# in

the space provided. Businesses should list their Business ID# (Bus. ID) where indicated (i.e. E.I.N.).

2. Severely Disabled Veteran Placard - Complete Sections A, D and E.

3. Temporary Placard - Complete Sections A, B and E. NOTE: Only licensed health care providers* may certify disabilities for temporary placards. Temporary

placards may be issued for a period up to six months and may not be extended for an additional period of time. When additional time is needed,

a new application must be completed and certified by a health care provider. In addition, please list your previous placard number.

4. Renewal Request - Complete Sections A and E.

5. Replacement Request - Indicate if applying for a replacement placard or ID card. Please check reason for replacement; Lost, Stolen, Defaced or Never

Received. List your previous placard number and complete Sections A and E. NOTE: If product was not received within 90 days, please check the

"Never Received" box or if product was not received for over 90 days please check the "Lost" box.

6. Change of Address - Complete Sections A and E.

7. Change of Name - Complete Sections A and E. Check the block on the front of this application to indicate reason for change of name.

* Health Care Provider is defined as a physician, chiropractor, optometrist, podiatrist, physician assistant, or a certified registered nurse practitioner

licensed or certified in Pennsylvania or a contiguous state. Health care providers may only certify disabilities within their scope of practice.

NOTE: Customers with a permanent placard have the option to renew their placard, request a replacement placard or change the address their placard online at

https://www.placard.penndot.pa.gov/PlacardWeb/public/external/placardLogin.xhtml or scan the QR code on the front of this application.

Placard Type

Person with

Disability

Placard

Severely

Disabled

Veteran

Placard

Eligibility Requirements

“Reason Codes”

Applicant:

(1) is blind.

(2) does not have full use of an arm or both arms.

(3) cannot walk 200 feet without stopping to rest.

(4) cannot walk without the use of, or assistance

from, a brace, cane, crutch, another person,

prosthetic device, wheelchair or other assistive

device.

(5) is restricted by lung disease to such an extent that

the person’s forced (respiratory) expiratory volume

for one 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.

(6) uses portable oxygen.

(7) has a cardiac condition to the extent that the

person’s functional limitations are classified in

severity as Class III or Class IV according to the

standards set by the American Heart Association.

(8) is severely limited in their ability to walk due to an

arthritic, neurological or orthopedic condition.

NOTE: If you are the parent or adult charged by law

with the natural parent’s rights, duties, and

responsibilities, acting on behalf of a minor child

(under 18) in place of the child’s natural parents

(person in loco-parentis), complete the appropriate

information on the front side of this application.

In addition, a parent, including an adoptive or

foster parent who has custody, care, or control of

the child or adult child or a spouse, may sign on

behalf of the child, adult child, or spouse

(applicant) provided the person with disability

meets eligibility requirements (1) through (8).

(1) 100% service-connected disability certified by the

U.S. Department of Veterans Affairs (Pittsburgh or

Philadelphia) or service unit in which the veteran

served or as shown on the applicant’s Letter of

Promulgation, Awards Letter, Single Notification Letter,

or Summary of Benefits Letter.

(2) Same disabilities as listed above for Person with

Disability Placard but must be service-connected.

Qualifying Vehicles

(1) The placard is required to be displayed

when the vehicle is parked in areas

designated for use by persons with

disability only and must not be

displayed when the vehicle is being

operated on the highway.

NOTE: Organizations that operate a

passenger vehicle to transport persons with

disabilities must supply the Department with

the following:

a) A notarized statement of how the

placard will be used and the type of

services that will be provided.

b) The weekly or monthly number of

hours that the services are provided.

c) The make of the vehicle(s), including

the title number, vehicle identification

number and registration plate

number. The vehicle(s) must be

titled in the name of the organization

and must be a passenger vehicle.

d) The number of placards required:

(Organizations may not be issued

more than eight placards in the

organization’s name.)

Same as 1 and 2 above for Person with

Disability Placard.

Benefits

(1) Parking permitted in

spaces designated for

disabled persons and

for 60 minutes in excess

of legal parking period

except where local

ordinances or police

regulations provide for

the accommodation

of heavy traffic during

morning, afternoon or

evening hours.

(2) Upon request of a

person with disability,

local authorities may

erect on the highway as

close as possible to the

person’s residence a

sign(s) indicating that

the place is reserved

for the person with

disability, that no one

else may park there

unless a person with

disability plate or

placard is displayed and

that any unauthorized

person parking there will

be subject to a fine.

Same as above for Person

with Disability Placard.

Use of Person with Disability and Severely Disabled Veteran Placards:

. Parking in a designated persons with disability parking space is only permitted with this parking placard when the vehicle is being used for the

transportation of the person for which the parking placard was issued.

. Any vehicle lawfully displaying a parking placard will qualify for parking in areas designated only for use by persons with a disability. NOTE: This

parking placard can not be used to park where parking is prohibited.

Send completed application to: PennDOT, Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268

Visit us at www.pa.gov/dmv or call us at 717-412-5300. TTY callers — please dial 711 to reach us.

↓ Mv 145A

File Properties

Fact Name	Fact Description
Form Purpose	The MV-145A form is used to apply for a parking placard for individuals with disabilities in Pennsylvania.
No Fee Required	There is no fee associated with submitting the MV-145A application.
Types of Placards	The form allows for the application of original, temporary, renewal, and replacement placards.
Eligibility Requirements	Applicants must meet specific criteria, including being blind or having limited mobility, as outlined on the form.
Health Care Provider Certification	A licensed health care provider must certify the disability for the application to be valid.
Notarization	Notarization is not required for the MV-145A application.
Submission Address	Completed applications should be sent to PennDOT, Bureau of Motor Vehicles, Harrisburg, PA.
Change of Information	Applicants can request changes to their name or address using this form.
Temporary Placard Duration	Temporary placards are valid for a maximum of six months and require re-certification for extensions.
Governing Law	The application process is governed by the Pennsylvania Vehicle Code, specifically 75 Pa.C.S. Section 7122.

Instructions on Utilizing Mv 145A

Filling out the MV-145A form is a straightforward process, but it's important to ensure all sections are completed accurately. After submitting your application, it will be reviewed by the appropriate department. If approved, you will receive your parking placard, which allows you to park in designated spaces for persons with disabilities.

Determine the type of request: Decide whether you are applying for a permanent placard, temporary placard, renewal, or replacement.
Complete Section A: Fill in your name, address, and other personal information. If you are acting on behalf of someone else, provide your relationship to the applicant.
Complete Section B or C: If applying for a permanent placard, complete Section B. If you are a severely disabled veteran, complete Section C. If applying for a temporary placard, complete Section B.
Certification from a health care provider: Ensure a licensed health care provider certifies the disability in the appropriate section. This is necessary for temporary placard requests.
Complete Section D: If applicable, have a police officer certify the disability. This is only necessary if you did not complete Section B.
Complete Section E: Sign and date the application. If notarization is required, ensure it is done in front of a notary public.
Submit the application: Send the completed form to PennDOT at the address provided on the form.

Important Facts about Mv 145A

What is the MV-145A form used for?

The MV-145A form is an application for a Person with Disability Parking Placard in Pennsylvania. This form allows individuals with disabilities to request a parking placard that grants them access to designated parking spaces. It can be used for original requests, renewals, replacements, or changes in personal information such as name or address.

Who is eligible to apply for a disability parking placard?

Eligibility for the disability parking placard is determined based on specific medical conditions. Individuals must meet one of the criteria listed on the form, such as being blind, having limited use of limbs, or being unable to walk without assistance. Additionally, parents or guardians can apply on behalf of minors or dependents.

What types of placards are available?

There are three types of placards available: Permanent, Temporary, and Severely Disabled Veteran placards. Permanent placards are issued for long-term disabilities, while Temporary placards are valid for up to six months. Severely Disabled Veteran placards are specifically for veterans with a 100% service-connected disability.

How do I apply for a temporary placard?

To apply for a temporary placard, complete Sections A, B, and E of the MV-145A form. A licensed health care provider must certify the disability. The temporary placard is valid for a maximum of six months and cannot be extended; a new application is required for additional time.

What should I do if my placard is lost or stolen?

If your placard is lost, stolen, defaced, or never received, you need to submit a replacement request on the MV-145A form. Indicate the reason for the replacement and complete Sections A and E. If the placard was not received within 90 days, check the "Never Received" box.

Is notarization required for the application?

No, notarization is not required for the MV-145A application. You simply need to complete the necessary sections and sign the application. However, if you are applying on behalf of someone else, ensure you provide the required information about your relationship to the applicant.

Where do I send the completed application?

Once you have completed the MV-145A form, send it to the Pennsylvania Department of Transportation (PennDOT) at the Bureau of Motor Vehicles, P.O. Box 68268, Harrisburg, PA 17106-8268. For further assistance, you can also visit their website or call their office directly.

Common mistakes

When filling out the MV-145A form for a person with a disability parking placard, applicants often make several common mistakes that can delay the processing of their application. Understanding these errors can help ensure a smoother submission process.

One frequent mistake is failing to check the appropriate box for the type of placard requested. The form offers options for original requests, renewals, replacements, and changes of address or name. If an applicant neglects to indicate their request type, it may lead to confusion and result in a rejected application.

Another common error is incomplete personal information. Applicants must provide the full name, address, and identification number of the person with a disability. Omitting any of these details can cause significant delays in processing, as the Department of Motor Vehicles (DMV) requires complete information to verify eligibility.

Inadequate or incorrect certification from a healthcare provider is also a prevalent issue. The form requires a licensed healthcare provider to certify the disability. If the certification is missing, incomplete, or not within the provider's scope of practice, the application will be deemed invalid.

Many applicants also overlook the need to list a previous placard number when applying for a replacement. This detail is crucial for the DMV to track and manage placards effectively. Failure to include this information can lead to processing delays or denial of the request.

Moreover, applicants sometimes forget to sign the application. The signature is a vital part of the form, as it confirms that the information provided is accurate. Without a signature, the application cannot be processed.

Another mistake involves not providing the required documentation for veterans. Veterans seeking a placard must include specific paperwork from the U.S. Department of Veterans Affairs. Failing to attach this documentation can result in an automatic denial of the application.

In some cases, individuals may incorrectly fill out the certification by a police officer section. This section is only necessary if the healthcare provider's certification is not completed. Misunderstanding this requirement can lead to unnecessary complications.

Additionally, applicants often neglect to check for any local ordinances that may affect their application. Each locality may have specific rules regarding disability placards, and being unaware of these can lead to issues during the application process.

Lastly, applicants may submit their forms without double-checking for errors. Simple typos or incorrect information can lead to rejections or delays. Taking the time to review the completed form can help catch these mistakes before submission.

By being aware of these common mistakes, applicants can improve their chances of a successful application for a disability parking placard, ensuring they receive the necessary accommodations without unnecessary delays.

Documents used along the form

The MV-145A form is an application for a Person with Disability Parking Placard in Pennsylvania. Alongside this form, there are several other documents that may be required to complete the application process or to support the request. Below is a list of these documents, along with a brief description of each.

Form MV-8: This form is needed if the applicant is listing an out-of-state address. It provides additional information to verify the applicant's residency and eligibility for the placard.
Health Care Provider Certification: This document must be completed by a licensed health care provider. It certifies the applicant's disability and confirms that it falls within the scope of practice of the provider.
Police Officer Certification: In cases where a police officer is certifying the disability, this document confirms that the applicant does not have full use of a leg or both legs, or is blind.
Veterans Affairs Documentation: For veterans applying for a placard, this includes a certification from the U.S. Department of Veterans Affairs or a photocopy of relevant benefits letters that confirm a 100% service-connected disability.
Notarization: While notarization is not required for the MV-145A form, some applicants may choose to have their signatures notarized for additional verification of identity.
Change of Address Form: If the applicant has moved, this form is used to update the address associated with the placard application.
Change of Name Form: This document is necessary if the applicant's name has changed. It ensures that the placard reflects the current legal name of the individual.
Replacement Request Form: If a placard is lost, stolen, or defaced, this form is used to request a replacement. It requires the previous placard number for reference.
Application for Renewal: This is used when an applicant needs to renew their permanent placard. It requires completion of specific sections to verify continued eligibility.

These documents serve various purposes in supporting the application for a disability parking placard. Ensuring that all necessary forms are completed and submitted can help streamline the application process and avoid delays.

Similar forms

The MV-145A form is specifically designed for individuals applying for a disability parking placard in Pennsylvania. It shares similarities with several other documents that serve related purposes. Here’s a list of seven such documents:

Form MV-8: This form is used for applicants with out-of-state addresses. Like the MV-145A, it requires detailed information about the individual with a disability, ensuring that the application is processed correctly.
Form MV-1: This is the application for a Pennsylvania vehicle title. Similar to the MV-145A, it requires personal identification and vehicle information, serving as a formal request to the state for a specific service.
Form MV-4ST: This form is for the sale or transfer of a vehicle. It, too, collects essential details about the parties involved, paralleling the MV-145A in its need for accurate information to facilitate the process.
Form MV-70: This is the application for a special plate for persons with disabilities. Like the MV-145A, it aims to provide individuals with the necessary credentials to access special parking privileges.
Form MV-41: This form is used for requesting a replacement driver’s license or ID card. Similar to the MV-145A, it requires personal information and a reason for the request, ensuring proper identification.
Form MV-44: This is the application for a Pennsylvania photo ID. It shares the same need for personal and identification details as the MV-145A, allowing individuals to obtain necessary documentation.
Form MV-120: This form is used for reporting a lost or stolen vehicle registration. Like the MV-145A, it requires the submission of specific details to verify the identity of the applicant and the circumstances of the request.

Each of these forms, while serving different purposes, emphasizes the importance of accurate information and documentation in accessing various services related to vehicle registration and disability support.

Dos and Don'ts

When filling out the MV-145A form, it's essential to follow certain guidelines to ensure a smooth application process. Here’s a list of things you should and shouldn’t do:

Do read the instructions carefully before starting the application.
Do complete all required sections accurately, including your name, address, and disability information.
Do ensure that a licensed health care provider certifies your disability if applying for a temporary placard.
Do sign the application in the presence of a notary if required.
Don’t leave any sections blank; incomplete forms may delay processing.
Don’t alter or forge any part of the application; this can lead to serious legal consequences.
Don’t forget to include any previous placard numbers if applicable.

By following these tips, you can help ensure that your application for a disability parking placard is processed efficiently and correctly.

Misconceptions

Misconceptions about the MV-145A form can lead to confusion and delays in obtaining a disability parking placard. Here are seven common misunderstandings:

Notarization is required. Many believe that notarization is mandatory for the MV-145A form. In fact, notarization is not required for any application type.
Only permanent placards are available. Some individuals think that only permanent placards can be issued. However, temporary placards are also available for those with qualifying disabilities, valid for up to six months.
Any doctor can certify disabilities. It's a common belief that any healthcare provider can certify disabilities for the form. In reality, only licensed providers within their scope of practice can do so.
Once issued, placards do not need renewal. Many assume that once they receive a placard, it remains valid indefinitely. However, permanent placards must be renewed, and temporary placards expire after six months.
The application can be submitted at any time. Some people think they can submit the application whenever they want. In fact, it's important to submit the application before needing the placard, as processing times may vary.
Eligibility is the same for all disabilities. A misconception exists that all disabilities qualify for the same benefits. Each condition has specific eligibility requirements outlined in the form.
Replacement placards are easy to obtain. Many believe that obtaining a replacement placard is a simple process. While it is straightforward, applicants must specify the reason for replacement and provide previous placard information.

Understanding these misconceptions can help streamline the application process and ensure that individuals receive the benefits they are entitled to.

Key takeaways

Key Takeaways for Filling Out the MV-145A Form:

Ensure you complete the correct sections based on the type of placard you are applying for: permanent, temporary, or for a severely disabled veteran.
Certification from a licensed health care provider is essential for temporary placards. This certification must be within their scope of practice.
Notarization is not required for any application type, including renewals and address or name changes.
When applying for a replacement, clearly indicate the reason (lost, stolen, defaced, or never received) and provide the previous placard number.
Submit the completed application to PennDOT at the specified address. For assistance, you can visit their website or call their office.