Metered Parking Waiver
New York State Department of Motor Vehicles
.
APPLICATION FOR A METERED PARKING WAIVER
FOR PERSONS WITH SEVERE DISABILITIES
Instructions for completing this application are on page 2. Take the completed application to the
issuing agent in the area where you live. Please bring your New York State driver license with you when you apply for the waiver.
INFORMATION ABOUT PERSON WITH DISABILITY - (Please print, and sign by the arrow.)
Address: No. and Street
City
M.1. I Date of Birth
I Zip Code I ~elePhone) No.
\D Male
D Female
Last Name
First
Apt. No.
\ State
Driver License Number and Expiration Date:
Do you have license plates for persons with disabilities? 0 No
Do you have a parking permit for persons with disabilities? 0 No
o Yes, plate number is:
o Yes, permit number is:
By signing this form I certify that I meet the requirements for a metered parking waiver. I understand that making a false statement
or providing misinformation on an application to obtain or facilitate the receipt of a metered parking waiver for people with
disabilities may result in a civil penalty ranging from $250-$1,000 and/or criminal prosecution and penalties.
-+
(Signature of Person with Disability or Signature of Parent or Guardian)- If signed by a parent or
guardian, please state your relationship to the person with the disability after your signature.
(Date)
MEDICAL CERTIFICATION-This section must be completed only by a Medical Doctor (MD) or Doctor of Osteopathy (DO).
The metered parking waiver is available to people who are severely disabled as defined in Vehicle and Traffic Law Section 404-a
(see Part A) AND who also have a disability that hinders their ability to put payment into a parking meter (see Part B).
.. Part A . Uses portable oxygen
. Legally blind
. Limited or no use of one or both legs
. Unable to walk 200 ft. without stopping
. Neuromuscular dysfunction that severely limits mobility
. Class III or IV cardiac condition. (American Heart Association standards)
. Severely limited in ability to walk due to an arthritic, neurological or orthopedic condition
. Restricted by lung disease to such an extent that forced (respiratory) expiratory volume for one second, when
measured by spirometry, is less than one liter, or the arterial oxygen tension is less than sixty mm/hg of room air
at rest
. Has a physical or mental impairment or condition not listed above which constitutes an equal degree of disability,
and which imposes unusual hardship in the use of public transportation and prevents the person from getting around
without great difficulty.
.. Part B Please certify that the severely disabled patient (as described in Part A) also has a severe disability
that limits one or more of the following (check all that apply):
o Fine motor control of both hands
o Ability to reach or access a parking meter due to use of a wheel-chair or other ambulatory device
o Ability to reach a height of forty-two inches from the ground due to lack of finger, hand, or upper extremity
strength or mobility.
MD/DO Name (PrintfType) Professional License No.
MD/DO Address (PrintfType) Telephone No.
( )
By signing this form I certify that this severely disabled patient (as defined by NYS Vehicle and Traffic Law Section 404-a) has a
disability limiting one or more of the actions listed in Part B above. I understand that making a false statement or providing
misinformation on an application to obtain or facilitate the receipt of a metered parking waiver for people with disabilities may
result in a civil penalty ranging from $250-$1,000 and/or criminal prosecution and penalties.
-+
(MD/DO Signature)
(Date)
File Information (For Issuing Agent use Only)
MV-664MP No. Issued:
Date Issued:
MV-664 No. Issued:
MV-664.1MP (1/08)
PAGE 1 OF 2
New York State Department of Motor Vehicles
INSTRUCTIONS FOR COMPLETING THE APPLICATION FOR A METERED PARKING WAIVER
The metered parking waiver is intended for use by those individuals whose severe disabilities make it extremely difficult to put
payment into a parking meter when traveling alone. Any person who makes a false statement or gives information which is known to
be false to a public official to obtain a metered parking waiver may be subject to a civil penalty of $250-$1,000 and possible criminal
prosecution.
In order to be eligible for the metered parking waiver, you must meet all of the following conditions:
1. Be a resident of New York State; and
2. Be a resident of the city, town, or village in which you are obtaining the waiver; and
3. Hold a valid New York State driver license; and
4. Are severely disabled as defined in Vehicle and Traffic Law Section 404-a (see Part A on page 1); and
5. Your severe disability as certified by a licensed physician limits one or more of the following:
a. Fine motor control in both hands; or
b. Ability to reach or access a parking meter due to use of a wheelchair or other ambulatory device; or
c. Ability to reach a height of 42 inches from the ground due to lack of finger, hand or upper extremity strength or mobility
Do you meet all of the requirements listed above in 1-5?
If No, you are not eligible for a metered parking waiver.
If Yes, continue on to Step 2.
ation About Person wit
Clearly print your personal information in the boxes provided.
Print your New York State driver license number and expiration date in the space provided. Your driver license number is
the 9 digit ID number located near your picture. The expiration date is printed in red on the bottom of the license. This
number needs to be a date in the future.
If you have license plates with the International Symbol of Access, check "Yes" and write your plate number in the space
provided. If you do not have those plates, check "No".
If you have a permanent (blue) parking permit for people with severe disabilities, check "Yes" and write the permit number in
the space provided. The permit number is a 6 or 7 digit number printed in black along the top portion of the permit. If you do
not have a permanent permit, check "No".
Read the certification statement and sign the form in the space provided.
II out the Medical Certification sectl
Bring the application form to your medical doctor or doctor of osteopathy. This form can only be filled out by a licensed
physician or doctor of osteopathy, not a nurse practitioner, chiropractor, physician's assistant or podiatrist.
The doctor should read Part A and read and fill out Part B by checking all of the disabilities that apply.
The doctor should print his or her name, license number, address and telephone number in the space provided.
The doctor must sign and date the form. (NOTE: Original signatures only.)
Issuing agents are often the town, village or city clerk or the local police department. You can not obtain a metered parking waiver
from any State or County Motor Vehicles office. Call your local city, town or village hall to find out where to apply for the waiver. If
you are a resident of Nassau County, call (516) 227-7399 to find out where to apply.
MV-664.1 MP (1/08)
www.nysdmv.com
PAGE 2 OF 2
METERED PARKING
WAIVER INFORMATION
New York State Department of Motor Vehicles
www.nysdmv.com
Beginning January 14,2008 a metered parking waiver is available to certain severely disabled drivers. This waiver allows
the holder to park in a metered parking space without putting payment into the meter. The waiver will only be issued to
people whose severe disability makes it extremely difficult to put payment into a parking meter. The eligibility and usage
requirements were created by the addition of New York State Vehicle and Traffic Law section 1203-h.
About the Metered Parking Waiver
The metered parking waiver allows the holder to park in a metered parking space in any city, town or village of New York
State without paying the meter fee. This applies to all metered parking spaces, even those that are not reserved for persons
with disabilities. However, there are certain restrictions that apply when using a metered parking waiver:
. The waiver holder must be driving the vehicle;
. The waiver holder must not be accompanied by a person who is able to put payment into a meter;
. The waiver holder must observe any time limits associated with metered parking spaces.
Please note: The metered parking waiver does not replace the parking permit or special license plates for the severely
disabled. When parking in a space reserved for the disabled, the vehicle must display the parking permit or special plates.
If you park in a space reserved for the disabled that has a parking meter, your vehicle must display the parking permit or
plates and the metered parking waiver for you to legally park in that space and not pay the fee.
Eligibility for a Metered Parking Waiver
In order to be eligible for a metered parking waiver, you must meet all of the following requirements:
1. Be a resident of New York State; and
2. Be a resident of the city, town, or village where you are applying for the waiver; and
3. Hold a valid, unexpired, New York State driver's license; and
4. Have a permanent, severe disability as defined in Vehicle and Traffic Law Section 404-a (see page 2); and
5. Have a severe disability that limits one or more of the following:
. Fine motor control in both hands
. Ability to reach or access a parking meter due to use of a wheelchair or other ambulatory device
. Ability to reach a height of 42 inches from the ground due to lack of finger, hand, or upper extremity
strength or mobility
If you do not meet all of these requirements, you are not eligible for a metered parking waiver.
Applying for a Metered Parking Waiver
The Department of Motor Vehicles does NOT issue metered parking waivers. The governing bodies of
cities, towns and villages appoint an agent to issue the waivers. The waiver is issued by most city, town or village clerks,
and some police departments. Call your local city, town or village hall to find out where to apply for the waiver. If you are
a resident of Nassau County, call (516) 227-7399 to find out where to apply.
To apply for the waiver, you must complete an Application for a Metered Parking Wavier for Persons with Severe
Disabilities (form MV-664.1MP). You can get the application from the issuing agent or from the DMV web site at
www.nysdmv.com. Part of the application must be completed by a licensed physician to certify that you meet the criteria
listed under item #5 above. A licensed physician is the ONLY medical professional who can certi1)r that you meet the
criteria. Agents will only issue a metered parking waiver if the application provides all of the information requested,
including the applicant's signature, and the medical certification is correctly completed and signed by a licensed physician.
PAGE 1 OF 2
MV-664.2MP (2108)
What is a Permanent, Severe Disability?
An applicant for a metered parking waiver must have a disability covered by Section 404-a of the Vehicle and
Traffic Law. This means the applicant must have one or more of the following impairments, disabilities or
conditions that are permanent in nature and affect mobility.
· Use of portable oxygen;
· Legal blindness;
· Limited use, or no use, of one or both legs;
· Inability to walk 200 feet without stopping;
· A neuro-muscular dysfunction that severely limits mobility;
· A Class III or IV cardiac condition (American Heart Association standards);
· Severe limitation in the ability to walk due to an arthritic, neurological or orthopedic condition;
· Restriction because oflung disease to such an extent that forced (respiratory) expiratory volume for one
second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than sixty
mmlhg of room air at rest;
· Any other physical or mental impairment not previously listed which constitutes an equal degree of
disability, and imposes unusual hardship in the use of public transportation and prevents the person from
getting around without great difficulty.
These are the same requirements that individuals must meet to qualify for a permanent (blue) parking permit for
people with disabilities or license plates for people with disabilities. So if you have been issued either a blue
permit or plates for the disabled, you meet these criteria.
MV-664.2MP (2/08)
PAGE 2 OF 2