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Get Arizona Handicap Placard Application Form 2018-2024

Or eligibility and additional information see reverse side For renewals, use form # 40-0112, available online. APPLYING FOR (check only one)  Placard  Plate  Both I understand that by submitting this form I have read the front and back of this form and agree to take full responsibility for the use of the Disability Placard(s) or Plates that are issued to me. Name of person with disability (first, middle, last) – please print Date of Birth Arizona ID or Driver License # Arizona S.

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