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The State Form 42070 is a crucial application for individuals seeking disability license plates or parking placards in Indiana. This form primarily serves two purposes: it allows eligible individuals to obtain a disability license plate or apply for a disability parking placard. The application process requires specific information from the applicant, including personal details and the nature of their disability. A healthcare provider's certification may be needed to validate the applicant's disability status, ensuring that only those who meet the criteria can access these benefits. There are different fees associated with each type of application, such as $9.50 for a disability license plate and $5.00 for a temporary parking placard. Importantly, no fee applies for permanent placards. The form accommodates applications from both individuals and companies, extending support to various entities involved in assisting persons with disabilities. The instructions specify that parents can sign on behalf of minor children, while others must provide proper documentation to validate their authority. Applications can be submitted by mail, streamlining the process for applicants who may have mobility challenges. Each section of the form addresses different requirements with clear guidance to facilitate successful completion.

State 42070 Example

APPLICATION FOR DISABILITY LICENSE PLATE OR PARKING PLACARD

State Form 42070 (R18 / 6-18)

INDIANA BUREAU OF MOTOR VEHICLES

R eF so

Bureau of Motor Vehicles

Winchester Mail Processing

Center PO Box 100

Winchester, IN 47394

(888) 692-6841

* This agency is requesting disclosure of your Social Security Number in accordance with IC 4-1-8. Disclosure is voluntary and you will not be penalized for refusal.

INSTRUCTIONS: 1. Complete in blue or black ink or print form.

2.To apply for a new disability license plate, complete Sections 1 and 2. To apply by mail, include payment of $9.50 (IC 9-18.1-11-10) in the form of a check or money order made payable to the BMV.

3.To apply for a disability parking placard, complete Sections 1 and 3. The fee for a temporary parking placard is $5.00 (IC 9-18.5-8-7(c)). To apply by mail, include payment of $5.00 in the form of a check or money order made payable to the BMV.

There is no fee for a permanent parking placard or a parking placard issued to a company.

4.A health care provider must complete Section 4 except when the applicant is a company, is requesting a replacement parking placard, or has received or is eligible to receive a Disabled Hoosier Veteran license plate.

5.Parents may sign this form on behalf of a minor child without any documentation. Any other person signing on behalf of the applicant must provide a copy of the document that authorizes that person to sign on behalf of the applicant (i.e. POA or guardianship papers). You must indicate your position next to your signature (i.e. parent or POA).

6.Applications may be mailed to the Winchester Mail Processing Center at the address listed above.

SECTION 1 - APPLICANT INFORMATION

Name of Applicant (first, middle, last) (If corporation or agency, list name.)

Social Security Number* or Federal Identification Number

Date of Birth (mm/dd/yyyy)

Address (number and street)

City

State

ZIP Code

SECTION 2A - APPLICATION FOR DISABILITY LICENSE PLATE

I am eligible to receive a disability license plate because: (check one)

The Indiana Bureau of Motor Vehicles has issued me a permanent parking placard.

I am certified by a health care provider in Section 4 of this application as having a permanent disability.

I represent a corporation, limited liability company, partnership, unincorporated association, or any legal successor of a corporation, limited liability company, partnership, or unincorporated association, that is authorized by the state or a political subdivision to operate programs, including the provision of transportation, or facilities for individuals with disabilities. (In the comments section below, a statement must be provided of how the

company qualifies for the disability license plate.) Comments:

I swear or affirm under the penalties for perjury that the information in this application is true and correct. I understand it is a Class C misdemeanor to knowingly and falsely profess to have the qualifications to obtain a license plate for a person with a disability.

Signature of Applicant (or company representative)

Printed Name

Date Signed (mm/dd/yyyy)

SECTION 2B - VEHICLE OWNER NOT DISABLED APPLICANT

If the applicant is not the vehicle owner, the vehicle owner must complete this section. The disabled applicant must complete Sections 1 and 2A and obtain a health care provider’s certification in Section 4, if required.

Name of Vehicle Owner (first, middle, last) (if corporation or agency, list name)

Security Social Number* or Federal Identification Number

Date of Birth (mm/dd/yyyy)

 

 

 

 

 

 

 

 

 

 

 

 

Address (number and street)

City

 

 

 

 

 

 

 

 

State

ZIP Code

 

 

 

 

 

 

 

 

 

 

 

 

I swear or affirm under the penalties for perjury that my vehicle regularly transports the disabled applicant.

Signature of Vehicle Owner (or company representative)

Printed Name

Date Signed (mm/dd/yyyy)

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SECTION 3 - APPLICATION FOR A DISABILITY PARKING PLACARD

I am applying for the following type of disability parking placard: (check one)

Permanent (expires only upon the health care provider’s certification that the person’s disability is no longer permanent)

Temporary (expires on the date indicated by the health care provider or one (1) year after the date of issuance, whichever occurs first) Company (expires on January 1 of the fourth year after the year in which the placard is issued or the date on which the company ceases operations, whichever occurs first)

I am eligible to receive a disability parking placard because: (check one)

I am certified by a health care provider in Section 4 of this application as having a permanent or temporary disability.

I am applying for a duplicate placard because the permanent or temporary placard previously issued to me has been lost, stolen, damaged, or destroyed.

I represent a corporation, limited liability company, partnership, unincorporated association, or any legal successor of a corporation, limited liability company, partnership, or unincorporated association, that is authorized by the state or a political subdivision to operate programs, including the provision of transportation, or facilities for individuals with disabilities. (In the comments section below, a statement must be provided of how the

company qualifies for the disability parking placard.)

I have been issued or am otherwise eligible to receive a Disabled Hoosier Veteran license plate.

Comments:

I swear or affirm under the penalties for perjury that the information in this application is true and correct. I understand it is a Class C misdemeanor to knowingly and falsely profess to have the qualifications to obtain a disability parking placard.

Signature of Applicant (or company representative)

Printed Name

Date Signed (mm/dd/yyyy)

SECTION 4 - HEALTH CARE PROVIDER’S CERTIFICATION

Name of Disabled Applicant (first, middle, last)

Date of Birth (mm/dd/yyyy)

I certify that the applicant has a qualifying disability as described in IC 9-18.5-8 and that such disability is: (check one)

Permanent

Temporary and is expected to end on:

/

/

(mm/dd/yyyy)

I further certify that the applicant has/is: (check one)

A physical disability that requires the use of a wheelchair, a walker, braces, or crutches. Lost the use of one (1) or both legs.

A severe restriction in mobility due to a pulmonary or cardiovascular disability, an arthritic condition, or an orthopedic or neurological impairment. Blind (as defined in IC 12-7-2-21(2)) or visually impaired (as defined in IC 12-7-2-198).

I certify that I am: (check one)

A physician with a valid and unrestricted license to practice medicine.

A physician who is a commissioned medical officer of the armed forces of the United States or the United States Public Health Service. A physician who is a medical officer of the United States Department of Veterans Affairs.

A chiropractor with a valid and unrestricted license under Indiana Code 25-10-1. A podiatrist with a valid and unrestricted license under Indiana Code 25-29-1.

An advanced practice registered nurse with a valid and unrestricted license under Indiana Code 25-23. A physician assistant with a valid and unrestricted license under Indiana Code 25-27.5.

An optometrist or ophthalmologist with a valid and unrestricted license to practice optometry or ophthalmology in Indiana.

Signature of Health Care Provider

Printed Name

Date Signed (mm/dd/yyyy)

 

 

 

 

Telephone Number

License Number

 

 

(

)

 

 

 

 

 

 

 

Address (number and street)

City

State

ZIP Code

 

 

 

 

 

A health care provider may certify that a person’s disability is no longer permanent by mailing a letter to the Indiana BMV explaining the person is no longer permanently disabled. Please provide as much of the person’s information as possible. Mail the letter to:

Indiana Bureau of Motor Vehicles, Registrations Department, 100 N. Senate Avenue, N483, Indianapolis, IN 46204

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Form Characteristics

Fact Name Description
Purpose of Form The State Form 42070 is used to apply for a disability license plate or parking placard in Indiana.
Governing Law This application is governed by Indiana Code IC 9-18.1-11-10 and IC 9-18.5-8.
Application Fee A fee of $9.50 is required for a new disability license plate, while a temporary parking placard costs $5.00.
Section Requirements Sections 1 and 2 must be completed to apply for a disability license plate, while Sections 1 and 3 apply for a parking placard.
Health Care Provider Involvement A health care provider’s certification is required in Section 4, unless the applicant is a company or qualifies for specific exemptions.
Minor Signing Rules Parents can sign on behalf of minor children without additional documentation; others must provide proof of authority.
Mailing Instructions Completed applications should be mailed to the Winchester Mail Processing Center at the designated address.
Validity of Placards Permanent placards expire only upon healthcare provider certification, while temporary ones expire within one year.
Misrepresentation Penalty Falsifying information to obtain a disability plate or placard is classified as a Class C misdemeanor.
Health Care Provider Certification Only qualified healthcare providers, like licensed physicians or chiropractors, can certify an applicant's disability.

Guidelines on Utilizing State 42070

Once you have obtained the State Form 42070, you are ready to begin the application process for a disability license plate or parking placard. Please follow the steps carefully to ensure your application is complete and accurate.

  1. Use blue or black ink to fill out the form or print it neatly.
  2. In Sections 1 and 2, provide your personal information if you are applying for a new disability license plate.
  3. If applying by mail for the disability license plate, include a payment of $9.50 as a check or money order payable to the BMV.
  4. For a disability parking placard, fill out Sections 1 and 3. Include a payment of $5.00 for a temporary placard if applying by mail, also payable to the BMV. Permanent parking placards have no fee.
  5. Section 4 must be completed by your health care provider unless you are a company, requesting a replacement, or already have a Disabled Hoosier Veteran license plate.
  6. If applying on behalf of a minor child, a parent may sign without additional documentation. Other representatives must include authorization documents.
  7. Indicate your position next to your signature if signing for someone else.
  8. Submit the completed form to the Winchester Mail Processing Center at the address provided on the form.

What You Should Know About This Form

What is the State 42070 form?

The State 42070 form is an application for a disability license plate or parking placard in Indiana. This form allows individuals with qualifying disabilities to obtain special parking benefits, making it easier to access various locations.

Who can apply for a disability license plate or parking placard?

Individuals with permanent or temporary disabilities can apply for a disability license plate or parking placard. If you are representing a corporation or organization that provides services for individuals with disabilities, you may also apply on their behalf.

How do I apply for a disability license plate using the form?

To apply for a disability license plate, complete Sections 1 and 2 of the form. If you are mailing your application, include a payment of $9.50 made out to the BMV. Ensure that you sign the application and provide true information.

What if I want a disability parking placard instead of a license plate?

If you prefer a disability parking placard, complete Sections 1 and 3 of the form. The fee for a temporary placard is $5.00. There is no fee for a permanent placard. Include the necessary payment if you're applying by mail.

Do I need a health care provider's certification?

Yes, a health care provider must complete Section 4 of the form, except when the applicant is a company requesting a replacement placard or if the applicant holds a Disabled Hoosier Veteran license plate. This section confirms the applicant's disability status.

Can I sign the form for my child?

Yes, a parent can complete and sign the form on behalf of a minor child without additional documentation. If someone else is signing for the applicant, they need to provide proof that they have the authority, such as power of attorney or guardianship paperwork.

How should I submit the completed form?

You can submit the completed form by mailing it to the Winchester Mail Processing Center at the address listed on the form. Be sure to include any necessary payments if you are applying by mail.

What happens if I provide false information on the application?

Providing false information on the application is a serious offense. It is considered a Class C misdemeanor, which can lead to legal consequences. Always ensure the information you provide is accurate and honest.

How do I renew a disability parking placard?

To renew a disability parking placard, you will need to apply for a new placard before your current one expires. If you have a temporary placard, a health care provider may need to confirm the ongoing disability through a new certification.

What if my placard is lost, stolen, or damaged?

If your placard is lost, stolen, or damaged, you can apply for a duplicate placard. Complete the relevant sections on the form and check the appropriate reasons for your application. There may be a fee for this duplicate placard.

Common mistakes

Filling out the State 42070 form requires attention to detail to ensure all information is correct. One common mistake is using the wrong ink color. The instructions clearly state that the form must be completed in blue or black ink. Using any other color, such as red or green, may lead to processing delays or rejection of the application.

Another frequent error involves leaving sections incomplete. Each section of the application needs to be fully addressed based on the applicant's circumstances. For example, an applicant may complete Sections 1 and 3 for a disability parking placard but neglect to fill out critical details in Section 4, where a health care provider’s certification is required. Failure to complete these sections properly can result in application denial.

Applicants often overlook the need for a health care provider’s certification. Section 4 must be filled out correctly by a qualified health care professional unless exceptions apply, such as in the case of a company requesting a placard. If Section 4 is missing or contains inadequate information, the application will not be considered.

Additionally, mistakes can occur when providing the Social Security Number. This piece of information is necessary for processing the application. Leaving it blank or entering incorrect numbers can lead to significant delays or complications. Therefore, double-checking this information beforehand is advisable.

People sometimes misinterpret the qualification requirements for the disability license plate or parking placard. It is crucial to check the appropriate box in Section 2A or 3 that corresponds to the eligibility criteria. Misunderstanding this section could lead to an application being denied for not meeting the stated qualifications.

Finally, applicants may forget to sign the document before submission. A signature is required in several sections of the form, and without it, the application will be considered incomplete. Therefore, it is important to review the entire form carefully, ensuring all signatures are affixed where necessary before mailing it.

Documents used along the form

When applying for the disability license plate or parking placard using the State Form 42070, there are several related forms and documents that may be necessary to complete the process efficiently. Each of these documents serves a distinct purpose in ensuring eligibility and compliance with state regulations.

  • Health Care Provider Certification Form: This form is crucial for verifying the disability status of the applicant. A qualified healthcare provider must complete this form to confirm whether the disability is permanent or temporary and to detail the nature of the applicant's condition.
  • Power of Attorney (POA) Document: If someone is signing the application on behalf of the applicant, a POA document should accompany the submission. This legal document verifies that a designated person has the authority to act on behalf of the applicant regarding the application process.
  • Identity Verification Documents: To prevent fraud, applicants must provide documents that verify their identity. This might include a state-issued ID, driver's license, or other government-issued identification that establishes the applicant’s identity and residency.
  • Vehicle Registration Documents: If the vehicle is owned by someone other than the applicant, the vehicle owner must provide proof of registration. This ensures that the vehicle linked to the application is correctly registered and eligible for disability-related accommodations.
  • Payment Receipt or Proof of Payment: Depending upon whether the applicant is applying for a permanent or temporary placard, a payment receipt or proof of payment is necessary. This record shows that the required fees have been paid, which is essential for processing the application.

In conclusion, gathering these additional forms and documents can streamline the application process for a disability license plate or parking placard. By ensuring that all necessary paperwork is completed and submitted, applicants can reduce delays and improve the chances of a successful application.

Similar forms

  • Application for Handicapped Parking Permit: This document is similar as it allows individuals with disabilities to apply for parking privileges. It typically requires information about the applicant's disability and may also need a healthcare provider's certification.

  • Vehicle Registration Application: Both forms require applicant information and are submitted to a motor vehicle department. They seek proof of eligibility before issuing permits or plates.

  • Personalized License Plate Application: Just like the State 42070 form, this application is for individuals wanting specific license plate designs that fit certain criteria. Both processes require payment and some form of certification.

  • Temporary Disability Placard Application: This document shares a similar purpose in granting access to disabled parking. It also demands details about the individual’s disability and usually needs a certification from a healthcare professional.

  • State Identification Card Application: Similar in structure, this application gathers personal information and checks the eligibility of individuals for state-issued identification, including those who may qualify based on disability status.

Dos and Don'ts

When filling out the State Form 42070, there are key guidelines to follow to ensure a smooth process. Here’s a list of things to do and avoid while completing this important application for a disability license plate or parking placard.

  • Use blue or black ink. Always use blue or black ink or print the form to ensure clarity.
  • Complete all required sections. Fill out Sections 1 and 2 for a disability license plate or Section 1 and 3 for a parking placard.
  • Provide accurate information. Double-check that all details, including names and dates, are correct to prevent delays.
  • Include the necessary fees. Make sure to enclose the correct payment if applying by mail, such as a check or money order made payable to the BMV.
  • Sign and date the form. Your signature indicates that the information provided is accurate and that you understand the penalties for false claims.
  • Have a healthcare provider complete Section 4, unless exceptions apply, such as for companies or for individuals already holding a Disabled Hoosier Veteran plate.
  • Mail to the right address. Ensure that applications are sent to the Winchester Mail Processing Center as specified in the instructions.
  • Do not forget to indicate your position next to your signature if signing on behalf of another person.
  • Do not use pencil or any ink color other than blue or black.
  • Do not leave any required sections blank. Complete all fields to avoid processing issues.
  • Do not delay submitting your application. Prompt submission helps ensure timely processing.
  • Do not submit a photocopy of the form instead of the original, unless instructed otherwise.
  • Do not forget to provide additional documentation if someone other than a parent signs on behalf of a minor.
  • Do not assume the application can be submitted via email or through other means without prior instruction.

By following these guidelines closely, applicants can streamline their experience when requesting a disability license plate or parking placard, avoiding unnecessary roadblocks along the way.

Misconceptions

Understanding the State Form 42070 is crucial for those seeking a disability license plate or parking placard in Indiana. Here are ten common misconceptions about this form and the facts that clarify them:

  • Misconception 1: The form requires a fee for all applications.
  • Only certain applications involve a fee. For example, a temporary parking placard costs $5.00, while a new disability license plate requires a $9.50 fee. Permanent parking placards are issued at no charge.

  • Misconception 2: Only the applicant can sign the form.
  • While the applicant usually needs to sign, parents can sign on behalf of minor children without additional documentation. Others must provide proof of their authority, such as a power of attorney.

  • Misconception 3: You need a complicated procedure to apply.
  • The application process is straightforward. You simply fill out the necessary sections and may send the completed form by mail to the designated address.

  • Misconception 4: Healthcare provider certification is mandatory in all cases.
  • A healthcare provider's certification is required only in specific instances. Notably, companies seeking placards do not need this section completed.

  • Misconception 5: You cannot apply for both a license plate and a placard simultaneously.
  • It is indeed possible to apply for both simultaneously. Just ensure that you complete the relevant sections for each request.

  • Misconception 6: The Social Security Number is mandatory for all applicants.
  • Disclosure of a Social Security Number is requested, but it is voluntary. Applicants can decline to provide it without penalty.

  • Misconception 7: The form doesn’t need to be filled out in specific ink colors.
  • The application must be completed using blue or black ink. Do not use other colors, as this can complicate the processing of your application.

  • Misconception 8: Permanent parking placards are automatically renewed.
  • Permanent parking placards do not expire but can be revoked if a healthcare provider confirms the disability is no longer permanent.

  • Misconception 9: Only individuals with disabilities can apply.
  • Companies and organizations can also apply for placards or license plates if they transport individuals with disabilities, as outlined in the form.

  • Misconception 10: If your application is denied, you cannot reapply.
  • You may reapply after addressing the reasons for denial. Always check with the Indiana Bureau of Motor Vehicles if you need clarification on the process.

Key takeaways

Filling out the State Form 42070, which is the application for a disability license plate or parking placard in Indiana, involves several important steps. Below are key takeaways that can help ensure a smooth application process.

  • Be Clear and Accurate: Use blue or black ink to complete the form, ensuring all details are legible and accurate.
  • Section-Specific Requirements: If you are applying for a disability license plate, only Sections 1 and 2 need to be filled out. For a disability parking placard, fill out Sections 1 and 3.
  • Fees: There is a fee of $9.50 for the disability license plate and $5.00 for a temporary parking placard. These fees should be submitted with the application in the form of a check or money order made out to the BMV.
  • Health Care Provider Certification: A healthcare professional must complete Section 4 unless the applicant is a company or requesting a replacement placard.
  • Parental Signatures: Parents can sign on behalf of their minor children without additional documentation. Other representatives must provide proof of authority, such as a power of attorney.
  • Mailing the Application: Completed applications can be sent to the Winchester Mail Processing Center at the specified address for processing.
  • False Claims: Be cautious when certifying qualifications. Falsely claiming to have a disability can lead to legal penalties.
  • Conditional Approvals: Temporary placards have expiration dates, while permanent placards require ongoing certification from a health care provider to confirm the disability status.