1115 Jack Wells Blvd-2025

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The document is a Paratransit Rider Application for LiftLine eligibility in Shreveport, Louisiana. It outlines the application process for individuals seeking transportation services due to disabilities that prevent them from using regular bus services. The application collects personal information, details about the applicant's disability, mobility aids used, and travel habits. It also includes a section for professional verification of the applicant's functional limitations affecting mobility.

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Click ‘Get Form’ to open the 1115 Jack Wells Blvd application in the editor.
Begin by filling in your personal information in Part 1. Enter your name, address, and contact details clearly. Ensure that you check the appropriate boxes for gender and whether you live in a nursing home.
In Part 2, provide your certification by selecting the reason for seeking LiftLine eligibility. Be honest and thorough as this information is crucial for your application.
Continue through the form by detailing any disabilities you have in Part 3. Use the provided checkboxes and space to describe your condition accurately.
For Part 4, list your current travel information, including frequent trips using LiftLine. This helps assess your transportation needs effectively.
Finally, review all sections for accuracy before signing at the end of the form. Utilize our platform’s features to save or print your completed application easily.

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Versions	Form popularity	Fillable & printable
2021	4.2 Satisfied (48 Votes)
2014	4.8 Satisfied (43 Votes)

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