555 Wright Way
Carson City, NV 89711
Reno/Sparks/Carson City (775) 684-4DMV (4368)
Las Vegas area (702) 486-4DMV (4368)
Rural Nevada or Out of State (877) 368-7828
Fax (775) 684-4797
www.dmvnv.com
SP27 (Rev 7/2019)
Driving Nevada
DISABLED PERSONS LICENSE PLATES AND/OR PLACARDS APPLICATION
NRS 482.384
First time applications for Disabled Persons license plates, motorcycle or moped license plates must be made in person.
In order to apply for disabled persons license plates or disabled motorcycle stickers your name must appear on the vehicle
certificate of registration and provide your current Nevada evidence of insurance. If your vehicle is currently registered, you have
the option of maintaining your current vehicle registration expiration date, or renewing for a full twelve (12) month period. Credit
for any unused portion of your current registration is transferable to your disabled license plate registration. In applicable counties,
if you are renewing for a full 12-month period, and your previous emissions test was obtained more than 90 days ago, the vehicle
must be re-tested prior to registration. You must have a permanent disability to qualify for disabled persons license plates
(see description below). If the Physician’s, APRN’s, or Physician’s Assistant portion is not completed in full, this application
cannot be processed.
Erasures
or whiteout will void this form.
Applicant Must Complete this Portion
You may select two (2) placards, or license plates and one (1) placard. If applying for license plates you must go to your local
DMV and provide your current Nevada evidence of insurance.
Disabled License Plates (permanent disability only) Disabled Placard(s) (no fee for placards) One Two
Disabled Motorcycle Plate (permanent disability only) Disabled Motorcycle Sticker (permanent/moderate)
Disabled Moped Plate (permanent disability only) Disabled Moped Sticker (permanent/moderate)
Please Print or Type
Full Legal Name
(Disabled Person)
First Middle Last
Nevada Driver’s License or Identification Card Number
Date of Birth
Physical Address
Address City State Zip Code
Mailing Address
Address City State Zip Code
County of Residence
Telephone No
I declare under penalty of perjury that the information on this application is true and correct.
I unde
rstand that a violation of the use of disabled person license and placards is a misdemeanor violation of
NRS 484B.467 and punishable by fines.
_________________________________ ____________
Signature of Applicant Date
SP27 (Rev 7/2019)
Please Print or Type Full Legal Name
(Disabled Applicant)
First
Middle
Last
A LICENSED PHYSICIAN, ADVANCED PRACTICE REGISTERED NURSE (APRN), OR PHYSICIAN’S ASSISTANT MUST
COMPLETE THIS PORTION
Please print or type and complete in full:
Please check one: Licensed Physician Advanced Practice Registered Nurse (APRN) Physician’s Assistant
Physicians, APRN’s, or Physician’s Assistant: Printed Name:
___________________________________________________________________________________________________________
First Middle Last
Physicians, APRN’s, or Physician’s Assistant: License No. ________________ State _________________
Mailing Address ____________________________________________________________ Telephone No. _____________________
Address City State Zip Code
As a Physician, APRN, Physician’s Assistant for the above-named patient, I hereby certify that the applicant:
1. Cannot walk two hundred feet without stopping to rest.
2. Cannot walk without the use of a brace, cane, crutch, wheelchair or prosthetic, or other assistive device, or another person.
3. Has a cardi
ac condition to the extent that functional limitations are classified as Class III or Class IV according to standards
adopted by the American Heart Association.
4. Is restricted by a lung disease to such an extent that the person’s forced expiratory volume for 1 second, when measured by a
spirometer, is less than 1 liter, or the arterial oxygen tension is less than 60 millimeters of mercury on room air while the
person is at rest.
5. Is severely limited in his/her ability to walk because of an arthritic, neurological, or orthopedic condition.
6 Has a visual disability.
7. Uses portable oxygen.
I further certify that my patient’s condition is a:
Temporary Disability (6 months or less) must indicate length of time not to exceed 6 months beginning _____________ and
ending _________________
Moderate Disability (reversible but disabled longer than 6 months)
Must indicate length of time not to exceed 2 years beginning _________________ and ending _________________
Permanent Disability (irreversible, permanently disabled in his/her ability to walk, certification is valid indefinitely).
Physicians, APRN’s, or Physician’s Assistant: Signature ______________________________________________________________
Date __________________________
FOR OFFICE USE ONLY
Plate/Placard Number(s) ________________ ___________________
DMV Tech Initials _____________ Date Issued ________________
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