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INSTRUCTIONS:
DMV Driver Transactions Unit
1905 Lana Ave NE
Salem, Oregon 97314
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RESIDENCE$''5(66STREET $''5(66$1'$3$570(17180%(5,)$33/,&$%/(
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.
;
APPLICANT6,*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
expiration date visible from the front of the vehicle.
• 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
1. You and your physician complete the appropriate sections below. NOTE: Incomplete applications will not be processed.
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)
RESET FORM
Individual and Wheelchair User, valid for eight years from date of issuance
Must be certified by your doctor as a person with a disability (see definition below) and wheelchair user if
applying for that permit.
Wounded Warrior (decal for Individual permit), valid for eight years from date of issuance
Must qualify for an Individual permit; a sevice-connected disability alone is insufficient. In addition to this
completed application, you must also provide both:
a. A letter from the Veterans' Administration indicating 50% or greater service-connected disability; and
b. A document reflecting discharge status other than dishonorable issued by any branch of the Armed
Forces of the United States or the United States Department of Veterans' Affairs.
Temporary Disability, valid for up to six months
For drivers who are temporarily disabled for less than four years. Must reapply if still needed after six months.
Decals, valid for the duration of the Individual permit
For placement on golf carts, motorcycles or similar vehicles for drivers already holding an individual permit.
Temporary Travel, valid for 120 days
For persons with disabilities who already have a Disabled Person Parking Permit placard and want a second
placard for travel purposes only.
Foreign Visitor, valid for up to 30 days
For persons with disabilities visiting from outside the US who hold a disabled person parking permit in their
country of passport issuance.
Oregon Revised Statutes (ORS):
801.387 "Person with a disability."
(1) A person who has a severely limited mobility because of paralysis or the loss of use of some or all of the person's
legs or arms; (2) A person who is affected by loss of vision or substantial loss of visual acuity or visual field beyond
correction; or (3) A person who has any other disability that prevents the person from walking without the use of an
assistive device or that causes the person to be unable to walk more than 200 feet, including but not limited to:
Chronic Heart Condition; Emphysema; Arthritis; Rheumatism; or Ulcerative colitis or related chronic bowel disorder.
811.616(2) Oregon Wounded Warrior Placard
A person is a wounded warrior who qualifies for an "Oregon Wounded Warrior" parking permit if the person:
(a) Submits written proof to the Department of Transportation of having a United States Department of Veterans
Affairs total disability rating of at least 50 percent as a result of an injury or illness that the veteran incurred, or that
was aggravated, during active military service; and (b) Received a discharge or release under other than
dishonorable conditions.
Oregon Administrative Rules (OAR):
735-080-0020(3) Oregon Wounded Warrior
An Oregon Wounded Warrior placard or decal is an individual or wheelchair user disabled person parking placard or
decal with the addition of a sticker saying "Oregon Wounded Warrior"... If the issuance of the Oregon Wounded
Warrior permit is the first issuance of a disabled person parking permit, DMV will include the placard, decal or both
per the applicant's request.
PERMIT TYPES, Period of Validity, Requirements:
STATUTES AND RULES