PLEASE NOTE: THE PLACARD MAY ONLY BE DISPLAYED WHEN 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name in the designated fields: Last, First, and Middle. Ensure accuracy as this information is crucial for identification.
3. Fill in your mailing address where you receive mail. If applicable, also provide your physical address without using a PO Box.
4. Input your Social Security Number and Vermont License or Permit Number. This information helps verify your identity.
5. Indicate your date of birth in the specified format (mm/dd/yyyy) to confirm eligibility.
6. Answer the medical form question regarding previous submissions within the last four years with a simple 'Yes' or 'No'.
7. Select the type of placard you are requesting and specify how many placards you need.
8. If applying for a replacement, indicate if your previous placard was lost, stolen, or destroyed and provide its number if available.
9. Finally, sign and date the application. If signing on behalf of an organization, include your title.

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