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INSTRUCTIONS:
DMV Driver Transactions Unit
1905 Lana Ave NE
Salem, Oregon 97314
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Wheelchair
Renewal
Individual
Decal (select one):
Temporary Travel
_ Golf Cart
Foreign Visitor
Wounded Warrior (Decal)
Temporary Disability
Motorcycle
Other (describe):
Replacement (of unexpired parking permit placard) because: (select one)
Lost
Stolen Mutilated
I certify by my signature below that I am eligible for a Disabled Person Parking Permit as defined in ORS 801.387 "Person with a Disability" (see page two) and the
information on this application is true and correct. I understand that knowingly making a fraudulent application is a crime punishable by jail time, a fine, or both.
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APPLICANT6,*1$785(
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• Remove the placard from your rear view mirror before driving your vehicle.
• Apply decals to the back left of the rear view, where possible, or the front fender of the vehicle with the permit number and
• Parking privileges DO NOT apply to a zone where: stopping, parking or standing is prohibited; late evening or overnight
parking is prohibited; and parking is reserved for special types of vehicles or activities.
• Permits are invalidated when: DMV receives notice of death of the holder; the holder surrenders their Oregon driver
license, permit, or ID in another jurisdiction; the permit was obtained fraudulently; and/or the person no longer qualifies for
the permit.
LICENSED PHYSICIANS AND HEALTHCARE PROVIDERS AUTHORIZED TO SIGN THIS CERTIFICATE INCLUDE: Doctors of Medicine,
Osteopaths, Podiatrists, Chiropractors, Naturopaths, Nurse Practitioners, Physician Associates, or licensed Optometrists.
NOTE
: Permits can be applied for and held by a minor. The permit and placard(s) belongs to the disabled individual(s), not the vehicle or a driver (other than the disabled individual).
*If the permit applicant does not have an ID and it would be impractical or harmful to obtain one by visiting a DMV Field office, an ID and
permit can be applied for at the same time using the Parking Identification Card and Disabled Person Parking Permit Application
(www.oregon.gov/odot/Forms/DMV/265PIPfill.pdf)
NEW?
NEW?
PERMIT TYPE APPLYING FOR (see reverse, select all that apply):
PARKING REGULATIONS:
Wheelchair User
Temporary
Non-Temporary
2. See reverse for Permit types, period of validity, and requirements.
3. You may submit the completed application in ONE of three ways:
2. Mail to:
1. Fax to: 503-945-5181
3. Take to any DMV office
(Please allow 10-14 days for processing and issuance)