Form MVD 96-0104, explained
MVD 96-0104 is Arizona’s application for a disabled parking placard. It has an applicant section you complete and a medical certification a licensed practitioner completes. It is free.
Where to get it
Download it free from Arizona Department of Transportation, Motor Vehicle Division. We link to the state’s own copy rather than hosting one, so you always have the current revision.
What the medical section needs
- Which of the state’s criteria apply, in the practitioner’s judgment.
- Whether the condition is temporary or permanent, and for a temporary placard, how long.
- The practitioner’s name, license number and signature. Arizona does not accept a stamped signature.
Who may sign it
In Arizona, a physician, osteopath, podiatrist, chiropractor, physician assistant, registered nurse practitioner, physical therapist or hospital administrator.
Where the signed form goes
For a placard, send the signed form to ADOT MVD Special Plates by mail, fax (602-239-6077) or email (specialplates2@azdot.gov), or take it to an MVD office. A placard application can be faxed or emailed, so there may be no office visit at all. The placard is free.
Need a doctor to complete it? An Arizona-licensed doctor can evaluate you online. Free 2-minute check ›