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Providing individuals with disabilities the ability to navigate with greater ease, the SP-41 form serves as a critical tool in New Jersey. This comprehensive document, issued by the Management Operation Services Special Plate Unit, underlines a process that streamlines the acquisition of vehicle license plates and/or a placard specially designated for persons with a disability. The form encompasses various sections targeting initial applications, recertifications, and replacements, ensuring users can maintain or update their status as needed. It touches on the necessity for a detailed personal identification section for the applicant, stipulations for wheelchair symbol license plates including the requirement of a photocopy of the vehicle registration, and conditions under which replacements for lost, damaged, or stolen items can be requested. Certification by the applicant and, if needed, by a medical practitioner or a disabled veteran representative, underscores the legitimacy of the claim, tying closely to specific conditions such as severe mobility impairments or significant respiratory, cardiac, or neurological conditions which qualify an individual for this aid. Finally, the form doesn’t shy away from legal terms, with stern warnings against false statements and the stipulations for usage, embodying New Jersey's commitment to equal opportunity while diligently preventing misuse of the privileges granted.

Preview - Sp41 Form

Application for Vehicle License Plates

and/or Placard for Persons

with a Disability

Management Operation Services Special Plate Unit

225 East State Street P.O. Box 015 Trenton, NJ 08666

609-292-6500 ext. 5061

This is my: Initial Application

Recertification Application

Replacement Application

I am applying for: License Plates Placard

Both

SECTION A: PERSONS WITH A DISABILITY IDENTIFICATION CARD INFORMATION

Name of Person with a Disability

Street Address

City, State, Zip Code

Driver License Number

Expiration Date

Date of Birth

Sex

Eye Color

Height

Weight

Daytime Telephone Number

I acknowledge that I hold a Commercial Driver License (CDL) and that this application may result in a medical review that could result in a decision that may affect my New Jersey CDL privilege.

Current Plate Number: _____________________________________________________________________________________________

Current Placard Number (for recertification applications): __________________________________________________________________

SECTION B: WHEELCHAIR SYMBOL LICENSE PLATES (Photocopy of Registration Required)

Registered Vehicle Owner’s Name

Vehicle Plate Number

Expiration Date

Registered Vehicle Owner’s Driver License Number

Expiration Date

Street Address

City, State, Zip Code

Relationship to the Disabled Applicant: Self Spouse Parent Guardian Other (Please Specify): _______________

SECTION C: REPLACEMENT PLATES, PLACARD AND/OR IDENTIFICATION CARD

License Plates

Placard

Identification Card

Vehicle Plate Number

Placard Number

Expiration Date

Expiration Date

Check One: Lost – attach a notarized statement of loss.

Damaged – return plate(s), placard, and/or both

Stolen – plate(s), placard – attach police report

SECTION D: CERTIFICATION OF STATEMENTS

I certify, under penalty of law, that the statements on this application are true.

Signature of Registered Vehicle Owner: ______________________________________________________ Date: _____________________

Signature of Person with a Disability: ________________________________________________________ Date: _____________________

Visit us at www.NJMVC.gov

New Jersey is an Equal Opportunity Employer

SP-41 (R11/20)

Application for Vehicle License Plates

and/or Placard for Persons

with a Disability

SECTION E: MEDICAL PRACTITIONER OR DISABLED VETERAN CERTIFICATION

Name of Medical Practitioner or Representative of the U.S.D.V.A.

Street Address

City, State, Zip Code

Daytime Telephone Number

Required prescription attached Required letterhead attached (ONLY for medical practitioners who are not authorized to write prescriptions OR a representative of the U.S.D.V.A.)

By law, eligibility for license plates and/or a placard for persons with a disability is limited to the following conditions. (NO OTHER PERSON IS ELIGIBLE FOR LICENSE PLATES AND/OR A PLACARD).

Patient Name (please print): _________________________________________________________________________________________

1.Has lost the use of one or more limbs as a consequence of paralysis, amputation, or other permanent disability.

2.Is severely and permanently disabled and cannot walk without the use of or assistance from a brace, cane, crutch, another person, prosthetic device, wheelchair or other assistive device.

3.Suffers from lung disease to such an extent that the applicant’s forced (respiratory) expiratory volume for one second, when measured by a spirometry, is less than one liter, or the arterial oxygen tension is less than sixty mm/hg on room air at rest; or uses portable oxygen.

4.Has a cardiac condition to the extent that the applicant’s functional limitations are classified in severity as Class III or Class IV according to standards set by the American Heart Association.

5.Is severely and permanently limited in the ability to walk because of an arthritic, neurological, or orthopedic condition; or cannot walk two hundred feet without stopping to rest.

6.Has a permanent sight impairment of both eyes as certified by the NJ Commission for the Blind (Placard only).

I CERTIFY, UNDER PENALTY OF LAW, THAT MY PATIENT (print name) ___________________________________________________

HAS BEEN PERSONALLY EXAMINED BY ME AND MEETS THE ELIGIBILITY CRITERIA AS SPECIFIED IN ITEM NUMBER(S) (select from above) ________________ AND THUS MEETS THE REQUIREMENTS FOR THE RECEIPT OF LICENSE PLATES AND/OR A

PLACARD FOR PERSONS WITH A DISABILITY.

Signature of Medical Practitioner or Representative of the U.S.D.V.A.: ________________________________________________________

SECTION F: TERMS AND CONDITIONS

1.Pursuant of 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.Wheelchair symbol license plates may be issued for one vehicle owned, operated or leased by a person with a disability or family member providing transportation for that person.

3.Wheelchair symbol license plates must be renewed every year, disability recertification is required every three years.

4.The 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.

5.Persons with a Disability Identification Card and placards must be recertified every three years.

6.The Motor Vehicle Commission requires that a person’s disability be recertified by a qualified medical practitioner and their qualification for license plates/placard as provided under N.J.A.C. 13:20-9.1(a) 4.

7.The persons with a Disability placard and/or license plates are to be used exclusively for a person with a disability named on the identification card. The identification card is nontransferable and shall be revoked is used by any other person. If the license plate and/or placard are no longer used by the person named on the identification card, they must be returned to the New Jersey Motor Vehicle Commission. Abuse of this privilege is cause for revocation of both the license plates and/or the placard.

8.Application for a Persons with a Disability Identification Card shall be submitted to the Motor Vehicle Commission not more than 60 days following the date upon which a medical professional or representative of the United States Department of Veterans Affairs certifies that the applicant meets the definition of “persons with a disability.”

I CERTIFY, UNDER THE PENALTY OF LAW, THAT I AGREE WITH THE TERMS AND CONDITIONS OF THIS APPLICATION.

Signature of Registered Vehicle Owner: ______________________________________________ Date: _____________________________

Signature of Person with a Disability: ________________________________________________ Date: _____________________________

Visit us at www.NJMVC.gov

New Jersey is an Equal Opportunity Employer

SP-41 (R11/20)

Form Data

Fact Name Description
Form Purpose Application for Vehicle License Plates and/or Placard for Persons with a Disability.
Organization Managed by New Jersey Motor Vehicle Commission, Management Operation Services Special Plate Unit.
Location 225 East State Street P.O. Box 015, Trenton, NJ 08666.
Contact Information 609-292-6500 ext. 5061
Type of Applications Includes Initial Application, Recertification Application, and Replacement Application.
Application Options Applicants can apply for License Plates, Placard, or Both.
Governing Laws Subject to N.J.S.A. 2C: 21-4(a), N.J.S.A. 2C: 43-3, and N.J.S.A. 2C: 43-6 regarding fraud and penalties.
Recertification Requirement Disability recertification is required every three years.

Instructions on Utilizing Sp41

Filing an application for vehicle license plates and/or a placard designated for persons with a disability is a process that requires attention to detail and careful submission of personal information and supporting documents. This process, governed by the New Jersey Motor Vehicle Commission (MVC), is designed to ensure that individuals with disabilities receive the accommodations they need in accordance with state laws. Whether one is applying for the first time, recertifying, or requesting a replacement, it is crucial to follow each step carefully and provide accurate information to avoid delays or denial of the application.

The steps below are crafted to guide applicants through the SP-41 form submission process:

  1. Identify the type of application you are submitting by checking the appropriate box: Initial Application, Recertification Application, or Replacement Application.
  2. Select what you are applying for: License Plates, Placard, or Both, by marking the corresponding box.
  3. Under SECTION A: PERSONS WITH A DISABILITY IDENTIFICATION CARD INFORMATION, fill in the name, street address, city, state, zip code, driver license number, its expiration date, date of birth, sex, eye color, height, weight, and daytime telephone number of the person with a disability.
  4. If applicable, acknowledge the CDL statement by checking the box provided.
  5. For recertification applications, enter the current plate and placard number.
  6. In SECTION B: WHEELCHAIR SYMBOL LICENSE PLATES, if applying for license plates, provide a photocopy of the vehicle's registration. Include the registered vehicle owner’s information, vehicle plate number, driver license number, and relationship to the disabled applicant.
  7. For replacement of plates, placard, and/or identification card in SECTION C, indicate what is being replaced by checking the appropriate box and provide the vehicle plate or placard number. Attach required documents in case of loss, damage, or theft.
  8. Complete SECTION D: CERTIFICATION OF STATEMENTS by signing and dating both portions for the registered vehicle owner and the person with a disability.
  9. In SECTION E: MEDICAL PRACTITIONER OR DISABLED VETERAN CERTIFICATION, provide the name, address, and daytime telephone number of the medical practitioner or U.S.D.V.A representative. Attach the required prescription or letterhead. Fill in the patient's name and check the applicable condition(s) that qualify them for the license plates/placard. The medical practitioner or representative must sign and date this section.
  10. Read and acknowledge the TERMS AND CONDITIONS in SECTION F by signing and dating the application form, both as the registered vehicle owner and as the person with a disability.

Once the form is carefully filled out and all necessary documentation is attached, submit the completed application to the address provided on the form. It's important to keep a copy for your records. Following submission, the New Jersey Motor Vehicle Commission will review the application. The process might include verification of the information provided and ensuring compliance with the eligibility criteria. Applicants may be contacted for additional information or clarification. Successful applicants will receive their license plates and/or placard in due course, facilitating their mobility and access to designated parking spaces. If there are any concerns or questions during the application process, reaching out to the MVC directly is advisable for personalized guidance and support.

Obtain Answers on Sp41

Below are frequently asked questions about the SP-41 form, which is used for applications related to vehicle license plates and/or placards for persons with disabilities in New Jersey.

  1. What is the SP-41 form?

    The SP-41 form is an application for New Jersey residents seeking to obtain vehicle license plates, placards, or both, specifically designed for persons with a disability. It encompasses initial applications, recertification, and replacements.

  2. Who needs to complete the SP-41 form?

    This form must be completed by individuals with a disability who require special vehicle license plates or a placard that permits parking in designated spaces. It is also used by those needing to recertify or replace existing plates or placards.

  3. What information is required to fill out the SP-41 form?

    Applicants need to provide personal identification information, details about the disability, current plate or placard information if applicable, and medical practitioner or disabled veteran certification verifying the disability. A signature certifying the truthfulness of the application and agreeing to the terms and conditions is also required.

  4. How often do I need to recertify my disability for the SP-41?

    Recertification for the use of disability license plates or placards is required every three years, as mandated by the Motor Vehicle Commission.

  5. What qualifies as a disability for the SP-41 form?

    Eligibility includes significant impairments like loss of limb use, severe and permanent mobility issues requiring assistance devices, severe lung or heart conditions, inability to walk without rest, and permanent vision impairment among others.

  6. Can I apply for both a placard and license plates?

    Yes, applicants can request either or both disability-specific license plates and a placard based on their needs and qualifying conditions.

  7. What are the penalties for providing false information on this form?

    Providing false information is a fourth-degree crime in New Jersey, potentially resulting in a fine up to $10,000 and/or imprisonment for up to 18 months.

  8. How can I submit the SP-41 form?

    Completed forms can be submitted to the Special Plate Unit at the address provided on the form or as directed by the New Jersey Motor Vehicle Commission (NJMVC).

  9. Where can I find more information or get assistance filling out the form?

    More information and assistance are available through the NJMVC's official website or by contacting their customer service number specifically for the Special Plate Unit.

Common mistakes

Filling out the SP-41 form, which is an Application for Vehicle License Plates and/or Placard for Persons with a Disability, requires careful attention to detail. Common mistakes can lead to delays or rejection of the application. To ensure a smoother process, here are seven mistakes often made during this task:

  1. Not specifying the application type: Applicants sometimes forget to check whether it’s an Initial Application, Recertification Application, or Replacement Application. This clarifies the purpose of the submission.

  2. Omitting personal identification details: The section requiring the Name of Person with a Disability, Street Address, City, State, Zip Code, and Driver License Number is often incompletely filled, which is crucial for identifying the applicant.

  3. Incorrect or incomplete vehicle information: In the sections designated for Wheelchair Symbol License Plates and Replacement Plates, Placard, and/or Identification Card, providing inaccurate vehicle registration details can complicate verification.

  4. Forgetting to include relationship status: If the Registered Vehicle Owner is different from the Person with a Disability, it’s essential to specify their relationship (e.g., Self, Spouse, Parent, Guardian, or Other).

  5. Neglecting to attach required documents: For Replacement applications, failing to attach a notarized statement of loss for lost items, or a police report for stolen ones, can stall the process.

  6. Incomplete certification section: Both the signatures of the Registered Vehicle Owner and the Person with a Disability are mandatory. Skipping these signatures renders the application incomplete.

  7. Not adhering to the medical certification requirements: The section designated for Medical Practitioner or Disabled Veteran Certification must be filled out accurately, ensuring that either a required prescription or a letter on official letterhead is attached, if applicable.

By paying close attention to these common areas of oversight, applicants can improve their chances of a successful application for the necessary vehicle accommodations to support Persons with a Disability.

Documents used along the form

When an individual submits an SP-41 form for vehicle license plates and/or a placard for persons with a disability, several other documents may become relevant depending on the circumstances. These forms and documents help in providing comprehensive information or fulfilling regulatory requirements associated with the application process. Below is a straightforward list of these documents and a brief description of each.

  • Medical Certification: A form or letter from a certified medical practitioner or a representative from the U.S.D.V.A., attesting to the applicant's disability and eligibility for the requested accommodations.
  • Notarized Statement of Loss: Required if the license plates or placard have been lost, this legal document formally declares the items as missing.
  • Police Report: Necessary if the plates or placard have been stolen, providing official proof of the theft for the application process.
  • Vehicle Registration: A copy must be submitted when applying for wheelchair symbol license plates, confirming the vehicle's current registration status.
  • Proof of Relationship: Documents that verify the relationship between the vehicle owner and the person with a disability, such as a marriage certificate or guardianship papers, would be necessary if the applicant is not the person with the disability.
  • Identification Card Application: A separate application for a Persons with a Disability Identification Card, if the applicant wishes to obtain or renew the card along with the plates or placard.
  • Prescription or Letterhead Certification: As mentioned in the form, for medical practitioners not authorized to prescribe or representatives of the U.S.D.V.A. who must certify the disability on official letterhead.
  • DMV Change of Address Form: Needed if the applicant has recently changed their address, to ensure all correspondence and issued items are sent to the correct location.
  • Driver License Application/Renewal: May be necessary if the person with the disability is also applying for, renewing, or updating their driver's license information in tandem with the SP-41 application.
  • Recertification Form: To be filled out every three years for disability recertification, as required for the continuous use of the plates or placard.

Understanding the purpose and requirements of each of these documents ensures a smoother application process for individuals seeking disability accommodations for their vehicles. The collection of correct documentation is critical in facilitating the mobility and independence of persons with disabilities. Always check with the relevant state department or official website for the most current forms and submission guidelines.

Similar forms

  • The Application for Handicap Parking Permit is similar because it also requires medical certification to verify the individual's eligibility for a handicap parking privilege, just as the SP41 form requires for persons with a disability to be eligible for license plates or placards.

  • The Driver's License Application parallels the SP41 form in that it collects personal information, such as name, address, and driver license number, which are necessary for identification and processing of the application.

  • An Application for Vehicle Registration shares similarities by requiring the vehicle owner's information, vehicle identification details, and registration period, akin to how the SP41 form addresses the ownership and details of vehicles for which disability plates or placards are sought.

  • The Renewal Application for Disabled Person Placard is related as it deals specifically with the renewal process for disability benefits associated with vehicle licensing, similar to a section of the SP41 which handles recertification for these services.

  • A Lost or Stolen License Plate Form has similarities with the SP41 form's section dedicated to replacement applications, requiring information on the lost, damaged, or stolen plates or placards.

  • An Application for Commercial Driver License (CDL) mirrors the SP41 form's acknowledgment of the potential impact on a CDL license when applying for disability-related vehicle modifications or designations.

  • The Change of Address Form for Motor Vehicle Registration is similar as it updates personal information in vehicle and licensing records, an aspect covered under the SP41 form when individuals need to ensure current and accurate data on their applications.

  • The Request for Medical Review Form is akin to the SP41 because it involves health and medical certification to assess an individual's condition in relation to driving capabilities and eligibility for disability-related vehicular modifications.

  • The Application for Veteran's License Plate shares a bond with the SP41 form by catering to a specific demographic (in this case, veterans) and also requires proof of status, just as disability status needs to be verified for the SP41 application.

  • A Temporary Placard Application is analogous as it provides a temporary solution for those with temporary disabilities, while the SP41 form caters to both permanent and temporary issues but with a focus on more enduring solutions.

Dos and Don'ts

When filling out the SP-41 form, an application for vehicle license plates and/or placard for persons with a disability in New Jersey, it's essential to approach the task with care and attention to detail. To ensure the process is handled correctly, here are some crucial dos and don'ts:

Do:
  1. Review the application thoroughly before beginning to fill it out. This will help you understand each section's requirements and gather necessary information or documentation.

  2. Ensure that all information provided in the application matches the documentation you're attaching, such as your driver's license, medical practitioner's certification, and any notarized statements of loss or police reports for replacement applications.

  3. Consult with a medical practitioner to accurately complete the certification section. It's vital that the medical condition meets the eligibility criteria clearly laid out in the form.

  4. Sign and date the form where required, both as the applicant and in acknowledgment of the terms and conditions, to certify the accuracy and truthfulness of the information provided.

Don't:
  1. Do not rush through the form, leading to possible errors or omissions that could delay the process or result in a denial of the application.

  2. Avoid guessing on dates or details. If you're applying for a replacement due to loss, damage, or theft, make sure the details match up precisely with any accompanying documentation.

  3. Do not leave sections blank that are applicable to your situation. Incomplete applications can result in delays. If a section does not apply, filling it with 'N/A' or 'Not Applicable' can be more helpful than leaving it empty.

  4. Never provide false information or forge signatures. The form clearly states that misrepresentation can result in significant penalties, including fines and imprisonment.

Following these guidelines will help ensure that your SP-41 form is filled out correctly and efficiently, making the process smoother for both you and the New Jersey Motor Vehicle Commission.

Misconceptions

When it comes to understanding the SP-41 form for obtaining vehicle license plates and/or a placard for persons with disabilities in New Jersey, there are several misconceptions that need clearing up. Here's a look at nine common ones:

  • The form is complicated and difficult to fill out. Actually, the SP-41 form is designed to be straightforward. It clearly outlines every section that needs completion, guiding applicants through the process.

  • It's only for drivers. This is a misconception. The form is not just for individuals who drive; it's also for those who need a placard for parking benefits due to their disability, and for family members or guardians who provide transportation.

  • You can get plates or a placard for temporary disabilities. The SP-41 form is intended for permanent disabilities as defined by specific criteria, including mobility issues, lung diseases, cardiac conditions, and severe sight impairment.

  • Any doctor can sign off on the application. The certification section must be completed by either a licensed medical practitioner or a representative of the U.S. Department of Veterans Affairs, confirming the applicant meets the defined eligibility criteria.

  • The disability placard is the same as the disability identification card. While they're related, they serve different purposes. The placard is used in vehicles for parking privileges, while the identification card helps verify the individual’s status as a person with a disability.

  • There's no need to renew the placard or plates. Actually, wheelchair symbol license plates must be renewed annually, and both the placard and the identification card require recertification every three years.

  • Using someone else's placard is fine if you're running errands for them. This is illegal. The placard and license plates are meant exclusively for the use of the individual with the disability. Misuse can result in revocation.

  • You don't need to recertify your disability. The Motor Vehicle Commission requires recertification of the person’s disability by a qualified medical practitioner, along with their qualification for license plates/placard, every three years.

  • The SP-41 form is only for New Jersey residents. While designed by the New Jersey Motor Vehicle Commission, non-residents with disabilities who frequently travel or work in New Jersey might also find this form relevant for their needs while in the state.

Clearing up these misconceptions brings clarity to the application process for vehicle license plates and placards for persons with disabilities, highlighting the importance of accurately completing and understanding the SP-41 form. Whether it's for an initial application, recertification, or replacement, the form plays a crucial role in ensuring individuals with disabilities have the mobility support they need.

Key takeaways

When filling out and using the SP-41 form for vehicle license plates and/or a placard for persons with a disability in New Jersey, there are several key takeaways to understand:

  • The SP-41 form serves multiple purposes: it can be used for initial applications, recertification, and replacement of license plates and placards for persons with a disability. It’s essential to check the appropriate box to indicate your specific need.
  • There is a section dedicated to medical practitioner or disabled veteran certification. This part is crucial as it requires a statement from a medical professional or a representative of the U.S.D.V.A. to certify that the applicant meets the eligibility criteria for a disability license plate or placard. This includes having a permanent impairment that significantly limits one’s ability to walk or a severe lung disease, among other conditions.
  • Applicants must be aware of the terms and conditions stipulated in the form, including the legal ramifications of providing false information. Misrepresenting your condition to obtain these special vehicle plates or placards is classified as a criminal offense that could lead to fines and imprisonment.
  • The form emphasizes the necessity for periodic recertification of the disability status. License plates need to be renewed yearly, with disability recertification required every three years. Similarly, Persons with a Disability Identification Card and placards must be recertified every three years, ensuring that only eligible individuals utilize these privileges.

Understanding these key takeaways ensures compliance with New Jersey's regulations for obtaining and maintaining vehicle accommodations for persons with disabilities. Always double-check your application for accuracy and completeness to avoid any complications in the process.

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