Designation of Mobility-Impaired License Plate

Louisiana designation of mobility-impaired license plate form

The Louisiana Designation of Mobility Impaired License Plate form is used when a mobility-impaired individual designates a special mobility-impaired license plate to a specific vehicle. This page provides the basic details, what information you should have ready, and a direct download link for the form.

What this form is used for

This form allows a mobility-impaired individual to designate their special license plate to a vehicle and documents the vehicle owner’s or lessee’s assent and acceptance. The form includes sections for the mobility-impaired individual or representative, the vehicle owner, and, when applicable, the vehicle lessee.

• Designating a mobility-impaired license plate to a specific vehicle
• Identifying the vehicle owner, vehicle year, make, model, and VIN
• Recording acceptance by the vehicle owner
• Recording acceptance by the vehicle lessee when the vehicle is leased
• Acknowledging that the plate may be canceled by written notice
• Acknowledging surrender requirements if the designation ends

Information you should have ready

• Name of the mobility-impaired individual
• Name of the vehicle owner
• Vehicle year, make, and model
• Vehicle identification number
• Signature of the mobility-impaired individual or representative
• Signature of the vehicle owner or lessee, when applicable
• Related plate, office, operator, and issue date details, if completed by the office

Why this form matters

Louisiana mobility-impaired plate paperwork needs to match the person, the vehicle, and the plate designation. If the plate is being used on a vehicle not titled in the mobility-impaired person’s name, the Louisiana OMV says the Designation of Mobility Impaired License Plate form, DPSMV 4222, must be completed and submitted. Title Authority can help you review the paperwork before submission, so that missing signatures or vehicle details do not slow the process.

Official Louisiana form source

You can review Louisiana mobility-impaired plate requirements through the official Louisiana OMV mobility-impaired hang tags and plates page.

Related Title Authority services and forms

• Handicap Plates
• Handicap Placards
• Auto Title Transfers
• Louisiana DPSMV 1799 Vehicle Application
• Schedule An Appointment

Download the form

Use the button below to download the Designation of Mobility Impaired License Plate form. You can complete it before your visit or bring it to Title Authority, and we will help you confirm the required vehicle and signature details.