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Get Az Dot 96-0104 2017
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How to fill out the AZ DoT 96-0104 online
The AZ DoT 96-0104 form is essential for individuals with disabilities seeking to obtain special plates or placards. This guide provides clear, step-by-step instructions on how to complete the application process online, ensuring a smooth and efficient experience.
Follow the steps to complete the application for disability plates or placards.
- Click ‘Get Form’ button to access the application form in your preferred online format.
- Select the type of application you are submitting by marking the appropriate box — either ‘New Plate’ or ‘New Placard’. For renewals, be sure to obtain form # 40-0112.
- Provide the applicant's name, which should include a person with a disability or hearing impaired, and fill in your phone number and date of birth.
- Enter your driver license number and physical address, including city, state, and zip code.
- If your application is not being submitted in person, include your mailing address. This is mandatory for applications sent via mail.
- For plate applicants only: Fill in vehicle information, including Vehicle Identification Number, year, make, and current plate number. This information must pertain to a vehicle owned or leased by the applicant.
- Complete the medical certification section by providing details from the authorized health professional. This section must include their name, medical license or certification number, phone number, and mailing address.
- Ensure the health professional provides their signature and the date the certification was completed. Note that a signature stamp is not accepted.
- If applicable, fill out the information stating why the medical certification was not completed by the authorized professional from another state, including the plate or placard number.
- Sign the application form, certifying that the information provided is accurate and that you understand the responsibility associated with the Disability Placard(s) or Plates.
- Review all entered information for accuracy before final submission. Upon completion, you can save your changes, download, print, or share the form as needed.
Complete your AZ DoT 96-0104 application online today for efficient processing and to obtain your disability plates or placards.
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To apply for a disability placard in Arizona, start by gathering the required documentation, including proof of your disability. You can complete the application form available through the AZ DoT 96-0104 webpage. After filling out the form, submit it along with any necessary medical certifications to your local motor vehicle division for processing.
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