Temporary Placard

BID #: SP-68

DUE: TBD

VALUE: $4.00

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Executive Summary

This document outlines the application process for a temporary placard in New Jersey, allowing individuals with temporary mobility limitations to access designated parking spaces. The application requires applicant information, medical practitioner certification, and adherence to specific terms and conditions. The temporary placard is valid for a maximum of 6 months from the date of issue and can only be recertified once for another period not exceeding 6 months. Applicants must certify their eligibility based on temporary loss of limb use, inability to ambulate without assistance, or other temporary mobility limitations. False statements or misinformation provided on the application can result in significant penalties, including fines up to $10,000 and imprisonment up to 18 months. Upon approval, the temporary placard must be displayed on the rearview mirror when the vehicle is parked in a designated wheelchair symbol parking space and removed during vehicle operation. Misuse of the placard is strictly prohibited, and it must be returned to the issuing Police Department if no longer needed.

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--- Document: Temporary Placard Document ---
New Jersey
Motor Vehicle Commission
STATE OF NEW JERSEY
APPLICATION FOR TEMPORARY PLACARD
INITIAL APPLICATION
RECERTIFICATION APPLICATION*
SECTION A: APPLICANT INFORMATION
Name of Applicant:
Special Plate Unit
P.O. Box 015
Trenton, New Jersey 08666-0015
888-486-3339 (NJ Toll Free)
609-292-6500 (Out-of-State)
$4.00 fee (payable to NJ MVC) attached.
Temporary Placard No:
(for recertification*)
Street Address:
City, State, Zip Code:
Driver License Number:
Date of Birth:
Sex:
Eye Color:
Ht:
Wt:
SECTION B: MEDICAL PRACTITIONER'S CERTIFICATION
Name of Medical Practitioner:
City, State, Zip Code:
National Provider Identification No. (NPI #):
Street Address:
Telephone number:
(required)
By law, eligibility for a Temporary Placard is limited to persons who have temporarily lost the use of one or more limbs, are
temporarily disabled so as to be unable to ambulate without the aid of an assisting device, or whose mobility is otherwise
temporarily limited. (NO OTHER PERSON IS ELIGIBLE FOR A TEMPORARY PLACARD).
I certify, under penalty of law, that my patient (print name)_
has been
personally examined by me and meets the eligibility criteria as specified above and thus meets the requirements for the
receipt of a Temporary Placard.
Signature of Medical Practitioner
SECTION C: TERMS AND CONDITIONS
Date
1. Pursuant to N.J.S.A. 2C:21-4(a), N.J.S.A. 2C:43-3, and N.J.S.A. 2C:43-6, making a false statement or providing misinformation on
an application to obtain or facilitate the receipt of license plates or placards for persons with disabilities is a fourth degree crime and
a person who has been convicted of this offense may be subject to pay a fine not to exceed $10,000 and a term of imprisonment of
up to 18 months.
2. The temporary placard must be displayed on the rearview mirror of the vehicle whenever such vehicle is parked in a designated
wheelchair symbol parking space and must be removed when the vehicle is in motion.
3. The Motor Vehicle Commission requires the applicant to be recertified by a qualified medical practitioner to extend the temporary
placard.*
4. Temporary placards are to be used exclusively for the person named on this application. The placard is nontransferable and will be
revoked if used by any other person. If the temporary placard is no longer used by the person named on the application, it must be
returned to the issuing Police Department.
5.
* The temporary placard is valid for no longer than 6 months from the date of issue and can only be recertified once, for a period
not to exceed 6 months.
BY SIGNING BELOW, I AGREE WITH THE TERMS AND CONDITIONS OF THIS APPLICATION.
Applicant's Signature:
Date:
FOR USE BY POLICE CHIEF
MUNICIPALITY
CHIEF SIGNATURE
TEMPORARY PLACARD #
SP-68 (R4/13)
ISSUE DATE
FEE PAID
EXPIRATION DATE

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"...Pursuant to N.J.S.A. 2C:21-4(a), N.J.S.A. 2C:43-3, and N.J.S.A. 2C:43-6, making a false statement or providing misinformation on an application to obtain or facilitate the receipt of license plates or placards for persons with disabilities is a fourth degree crime and a person who has been convicted of this offense may be subject to pay a fine not to exceed $10,000 and a term of imprisonment of up to 18 months...."

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