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Mississippi disabled parking application form 76 104 2025

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The document is a Mississippi Disabled Parking Application form that requires certification from a licensed physician or nurse practitioner regarding the applicant's disability. It outlines various conditions that qualify for disabled parking permits, including mobility limitations and respiratory or cardiac issues. The application includes sections for the physician's certification, tax collector's processing, and the applicant's declaration of truthfulness.

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In Section 1, have a licensed physician or nurse practitioner complete the certification. They will need to provide their printed name, address, and phone number, along with their signature and date.
In Section 2, select whether you are applying for a permanent parking placard, disabled license tag, or temporary parking placard. Fill in the required details such as tag number and title number.
In Section 3, as the applicant, certify that all statements are true by signing and dating the application. Ensure that you indicate your relationship to the vehicle owner if applicable.

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2008	4 Satisfied (43 Votes)

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How to get a handicap parking permit in Mississippi?

Individuals may apply for a disability tag/placard using the Mississippi Disabled Parking Application Form (PDF). This form must be certified by the applicants physician or nurse practitioner as being permanently disabled. Permanently disabled individuals may receive two disability tags and two placards.