KDOR Motor Vehicle Website
Kansas
DEPARTMENT OF REVENUE
DIVISION OF VEHICLES
CENTRAL OFFICE OPERATIONS
www.ksrevenue.org
COMMERCIAL VEHICLE OR CITY/COUNTY
OR OFFICIAL STATE VEHICLE LICENSE PLATE
APPLICATION FOR DISABLED PLATE DECAL
Fax completed and Signed form to (785) 291-3755


1. LICENSE PLATE, VEHICLE AND OWNER/OPERATOR INFORMATION

REQUIRED FOR ALL APPLICATION
The Information of the one who the vehicle is registered on:

2. CITY/COUNTY OR OFFICIAL STATE VEHICLE LICENSE PLATE

GOVERNMENT AGENCY ONLY

I affirm under penalty of law this application is true and correct and such disabled decaled plate shall be used by an agency that provides transportation for persons with a disability, as defined in K.S.A. 8-1,124, as a service. I also affirm the agency will only utilize disabled parking privilege when transporting at least one disabled person. I am aware making a false certification that the agency meets the qualifications of K.S.A. 8-1,125 could result in penalty set forth by statute.

Check for affirmation and signature (This is for Owner's Authorized Representative).

3. COMMERCIAL VEHICLE LICENSE PLATE

I affirm under penalty of low this application is true and correct and such disabled decaled plate shall be used by an business/agency that provides transportation for persons with a disability, as defined in K.S.A. 8-1,124, as a service. I also affirm the agency will only utilize disabled parking privilege when transporting at least one disabled person. I am aware making a false certification that the agency meets the qualifications of K.S.A. 8-1,125 could result in penalty set forth by statute.

Check for affirmation and signature (This is for Owner's Authorized Representative).