SECTION 1 - TO BE COMPLETED BY APPLICANT - eCCLIX 2026

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The document TC 96-204 is an application form for a Disabled Persons Special Parking Permit issued by the Kentucky Transportation Cabinet. It requires the applicant to provide personal information and have their disability attested by a county clerk and certified by a licensed physician, indicating whether the disability is permanent or temporary.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field. Ensure that you print clearly for legibility.
Next, provide your phone number. This is important for any follow-up communication regarding your application.
Fill in your address, including street or post office box, city, state, and zip code. Double-check for accuracy to avoid processing delays.
Select one of the checkboxes indicating whether you currently hold a disabled parking license or a disabled veteran license.
Sign the form where indicated as the applicant. This confirms that all information provided is true and accurate.
Lastly, enter your Social Security Number in the specified field to complete this section of the application.

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