Medical practitioner certifies a qualifying permanent disability (limb loss, inability to walk unaided, lung disease, AHA class III/IV cardiac, etc.) for initial, recertification or replacement wheelchair-symbol plates or placard.
- Completed by
- Medical practitioner (or U.S. Department of Veterans Affairs representative for disabled veterans)
- Issued by
- New Jersey Motor Vehicle Commission
- Format
- Fillable PDF
- Language
- English