Form REG195 Application for Disabled Person Placard or Plates - California

Form REG 195 Instructions

The application begins by detailing instructions on how to correctly use and display the placard or plates, who qualifies, and information for disabled veterans. It also details instances that are considered an illegal use of the placard or plates that can result in a fine and/or imprisonment if illegal use occurs.

1. The first section asks for the applicant's or organization's information, such as name, address, date of birth (for an individual applicant), mailing address, phone number, and driver license ID card number.
2. The second section has the applicant check off the type of disabled person parking placard(s) or license plate they will need, any cost associated with the placard (only the Temporary DP Parking Placard requires a fee) if the applicant has been issued a disabled person placard or plate in California before, and to list the license plate or parking placard number if they previously had been issued one.
3. The third section is only required for those requesting a license plate and asks for the license plate number, vehicle identification number (VIN), vehicle make and model, and a request for an exemption for the Commercial Vehicles Weight Fee (for vehicles weighing less than 8,001 when empty and can only be used for one commercial vehicle and no other vehicles owned by the person or organization).
4. The fourth section is the signature of the applicant or representative of the organization.
5. The fifth section is the authorized medical provider's information, such as the medical provider's name, license number, address, and daytime phone number.
6. The sixth section is the medical provider's certification of disability and contains eight questions the medical provider must complete for the individual applying for the plate or placard. This section also details the acceptable description that constitutes a disability according to California state law.
7. The seventh section requires the provider to list a full and legible description of the applicant's illness or disability that the applicant has that meets the state law for certification.