Form Dmv-41-Tr - Parking Application Form For A Mobility Impaired Person Page 2
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2Instructions for Completing the Form: DMV-41-TR
ALL APPLICANTS MUST BE WEST VIRGINIA RESIDENTS
1. The mobility impaired person MUST enter their Social Security Number in the light gray box on the upper right corner of
the page. DO NOT
2. The mobility impaired person completes Section 1 and signs the application.
3. A licensed physician completes Section 2. (Licensed physician includes MD., DO., Chiropractor, Advanced Nurse Practitioner,
and Physician’s Assistant)
4. Applicants requesting a mobility impaired license plate must be listed on the registration of the vehicle listed in Sub-Section C.
Division of Motor Vehicles
Mobility Impaired Placards and Plates
P O Box 17010
Charleston, WV 25317
Placard Information
1. When parked in a mobility impaired parking space, display the placard by hanging it on the rearview mirror, or, in the
absence of a mirror post, on the dashboard.
2. If a parking placard or special license plate has been lost, stolen, mutilated or destroyed, a replacement may be requested at
3. Permanent mobility impaired placards and plates privileges and the special ID cards are renewed every
years. Renewal
reminders will be mailed prior to expiration, to the address you have provided. However, the license plate expires each
year or every other year.
Situations that Warrant Returning Placards & Plates
1. The person to whom the permit has been issued is deceased or has moved out of state.
2. The person has found or has in his/her possession a permit that was not issued to that person.
3. The permit was reported lost or stolen and is later found after a duplicate has been issued.
Important Information
**It is unlawful to loan this placard to any person for any reason, regardless of whether that person is mobility impaired.
The mobility impaired person does not have to own or drive the vehicle to use the placard.
**Placard should be hung from the rearview mirror when parked but should be removed from the mirror when driving.
**Local governments designate parking spaces for persons with mobility impairments by local law or ordinance. Contact
your local government if you have a question about designated parking for the mobility impaired.
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