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TC96347 Rev.09/2018 Page1of1KENTUCKYTRANSPORTATIONCABINET DepartmentofVehicleRegulation DIVISIONOFMOTORVEHICLELICENSINGAPPLICATIONFORDISABLEDLICENSEPLATE ORPARKINGPLACARD INSTRUCTIONS:CompletethisformandforwardtoyourCountyClerk.SECTION1:APPLICANTINFORMATION(tobecompletedbyapplicantbeforesubmittingtoaphysician) Issuance NAME(individualororganization)2ndPlacardADDRESS(streetorpostoffice)Renewal.

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