Homepage Blank Louisiana Window Tint Exemption Sticker Form
Outline

The Louisiana Window Tint Exemption Sticker form serves an essential purpose for individuals who require medical exemptions from standard window tinting regulations. This form allows registered vehicle owners, or their immediate family members, to apply for a medical exemption that permits darker window tints than typically allowed under state law. To initiate the process, applicants must provide personal information, including their driver's license number, date of birth, and vehicle details. Importantly, the form requires a declaration of valid medical reasons for the exemption, which must be supported by a physician's statement detailing the specific medical condition, such as photophobia or lupus. The exemption is valid for three years but can extend for the lifetime of the vehicle ownership if the owner is aged 60 or older. Furthermore, the form includes a section for notary verification and mandates that the original certificate be carried in the vehicle at all times. Falsification or alteration of this document renders it void, emphasizing the importance of accuracy and honesty in the application process. Understanding the requirements and implications of this form is crucial for those seeking to navigate Louisiana’s window tint laws effectively.

Sample - Louisiana Window Tint Exemption Sticker Form

State of Louisiana

Parish of ___________________________

WINDOW TINT MEDICAL EXEMPTION AFFIDAVIT

Tint may be placed on the windshield being affixed to the topmost portion of the

windshield not to extend more than six inches down from the top.

FULL NAMEDRIVER’S LICENSE NUMBERDATE OF BIRTH

_____________________________________________________________

ADDRESS

CITY

 

STATE

ZIP

(AREACODE) PHONE NUMBER

 

 

 

 

 

YEAR

MAKE

MODEL

VEHICLE IDENTIFICATON NO.

LICENSE PLATE

___________________________________________________________________________

Vehicle Information

Affiant declares that he/she is the registered owner or the spouse or immediate family member having significant use of the above- described Louisiana registered vehicle. Affiant states that, pursuant to L.R.S. 32:361.2, valid medical reasons (indicated below) exist which makes it necessary to equip the above described vehicle with sun-screening material which would be of a light transmission or luminous reflectance in violation of L.R.S. 32:361.1.

Affiant further declares that he/she has not been convicted of any drug offense or any violent crime and authorizes the Department to perform a criminal history inquiry.

Further, Affiant authorizes the Louisiana State Police access to all medical records related to the medical condition which may qualify as an exemption under L.R.S. 32:361.1 as defined L.R.S. 361.2.

Exemption will be valid for the duration of ownership of a vehicle whose owner is age 60 years or older.

I certify and attest under penalty of law, the information provided herein is true and accurate.

__________________________________

_________________

SIGNATURE OF AFFIANT

 

 

DATE

___________________________________

 

 

NOTARY PUBLIC

 

 

 

___________________________________

________________

SEAL / NOTARY NUMBER

 

LSP Certificate Number

 

NOT VALID UNLESS AUTHORIZED BY LOUISIANA STATE POLICE

Approved & Authorized

Disapproved

 

________________________________

_________

________

TESS-MVI

For the Deputy Secretary, Public Safety Services

Data Number

Date

Section

 

 

 

 

DPSSP 1060 (REV 8/09)

 

 

PAGE 1 of 3

(Legal window tint is 40% light transmission.)

NOTE: L.R.S. 32:361.1 provides that the legal limits to the sun screening device (window tint) on a passenger car are light transmissions of 40% for the front side windows, 25% for the rear side windows and 12% for the rear windshield.

WINDOW TINT MEDICAL EXEMPTION

THIS MEDICAL EXEMPTION IS NON-TRANSFERABLE AND EXPIRES THREE (3) YEARS FROM DATE OF ISSUANCE. THE ORIGINAL CERTIFICATE MUST BE CARRIED IN THE VEHICLE AT ALL TIMES AND SHALL BE VOID IF ALTERED OR FALSIFIED.

BELOW THIS LINE FOR OPTOMETRIST OR PHYSICIAN’S USE ONLY

Patient’s Full Name ___________________________

Patient’s DOB ____________________

Indicate the below listed World Health Organization International Classification of Disease ICD- 9-CM recognized condition which would require a medical exemption under L.R.S. 32:361.2. Provide a complete and detailed description under the section indicated as “DESCRIBE”. Louisiana State Police may seek the Medical Advisory Board’s opinion whether to grant the medical exemption.

Albinoism Lupus (Lupus Family) Porphyria

Describe (All other)________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Photophobia as a medical condition requires an explanation as to the exemption under L.R.S. 32:361.2. Indicate in detail why a correct pair of sunglasses would not be adequate protection thus requiring the exemption under L.R.S. 32:361.2, and why this exemption under L.R.S.361.2 will not affect the individual’s ability to drive at night.

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Print Physician Name

Physician Signature

Date

(Area Code) Phone Number

DPSSP 1060 (REV 8/09)

 

 

PAGE 2 of 3

WINDOW TINT MEDICAL EXEMPTION

Official Use Only of the Medical Advisory Board

Date_____________________ Approved ____________________ Denied___________________

Reason for Approval or Denial

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

_________________________________

________

Advisory Board Physicians Signature

Date

LAC 55:813(T) The Medical Exemption Affidavit shall:

i. be valid for a period of not more than 3 years, except for the following provisions;

(a). The registered owner of the vehicle is 60 years and older at the time of application for a Medical Exemption Affidavit, or the individual becomes 60 years old while in possession of a valid Medical Exemption Affidavit, then the affidavit will be valid for the duration of that individual’s ownership of the vehicle as provided in LRS 32:361.2(A)(3)(c) unless deemed otherwise by the Department.

(b). The applicant for the Medical Exemption Affidavit is 60 years and older at the time of application for a Medical Exemption Affidavit, or the individual becomes 60 years old while in possession of a valid Medical Exemption Affidavit, but is not the registered owner of the vehicle, in which case the Department shall review the case as provided in LRS 32:361.2(A)(3)(b) and LRS 32:361.2(A)(3)(c).

DPSSP 1060 (REV 8/09)

PAGE 3 of 3

Form Information

Fact Description
Purpose The Louisiana Window Tint Medical Exemption Sticker form allows individuals with specific medical conditions to legally apply window tint that exceeds standard limits.
Governing Law This form is governed by Louisiana Revised Statutes L.R.S. 32:361.1 and L.R.S. 32:361.2, which outline the regulations for window tinting and medical exemptions.
Validity Period The medical exemption is valid for three years from the date of issuance, unless the vehicle owner is 60 years or older, in which case it lasts for the duration of ownership.
Non-Transferability The exemption is non-transferable and must be carried in the vehicle at all times. It becomes void if altered or falsified.
Medical Conditions Eligible medical conditions for the exemption include albinism, lupus, porphyria, and photophobia, among others, as recognized by the World Health Organization.

Detailed Guide for Filling Out Louisiana Window Tint Exemption Sticker

Filling out the Louisiana Window Tint Exemption Sticker form requires careful attention to detail. Follow these steps to ensure your application is completed accurately and efficiently.

  1. Obtain the form: Download the Louisiana Window Tint Exemption Sticker form from the official website or request a physical copy from your local DMV.
  2. Fill in your personal information: Write your full name, driver’s license number, and date of birth at the top of the form.
  3. Provide your address: Enter your complete address, including city, state, and zip code.
  4. Include contact information: Write your phone number, including the area code.
  5. Enter vehicle details: Fill in the year, make, model, vehicle identification number (VIN), and license plate number of your vehicle.
  6. Confirm ownership: Indicate that you are the registered owner or an immediate family member with significant use of the vehicle.
  7. State medical reasons: Clearly describe the valid medical reasons for needing the exemption, referencing the appropriate conditions listed on the form.
  8. Sign the affidavit: Sign and date the form to certify that the information provided is true and accurate.
  9. Notarization: Have the form notarized by a notary public, who will also provide their seal and number.
  10. Submit the form: Send the completed form to the Louisiana State Police for approval, ensuring you keep a copy for your records.

Once submitted, the Louisiana State Police will review your application. If approved, you will receive the exemption sticker, which must be displayed in your vehicle. Ensure to carry the original certificate at all times, as it is required by law.

Obtain Answers on Louisiana Window Tint Exemption Sticker

  1. What is the Louisiana Window Tint Exemption Sticker form?

    The Louisiana Window Tint Exemption Sticker form is a legal document that allows individuals with specific medical conditions to apply for an exemption from the standard window tint regulations. This form is necessary for those who require darker window tinting for health reasons, as defined by Louisiana law.

  2. Who is eligible to apply for this exemption?

    Eligibility is primarily for registered vehicle owners or their immediate family members who have significant use of the vehicle. The applicant must have a valid medical reason that falls under the recognized conditions, such as lupus or photophobia. Additionally, applicants must not have any drug offenses or violent crime convictions.

  3. How long is the exemption valid?

    The exemption is generally valid for three years from the date of issuance. However, if the vehicle owner is 60 years or older at the time of application, the exemption remains valid for as long as they own the vehicle, unless otherwise determined by the Department.

  4. What conditions qualify for the medical exemption?

    Conditions that may qualify include, but are not limited to, albinism, lupus, porphyria, and photophobia. Each condition requires a detailed explanation from a physician, outlining why standard sunglasses would not suffice for protection.

  5. What documentation is required for the application?

    Applicants must provide personal information, including their full name, driver's license number, date of birth, and vehicle details. A physician's statement is also required, detailing the medical condition and justifying the need for the exemption. The original certificate must be carried in the vehicle at all times.

  6. Can the exemption be transferred to another person?

    No, the medical exemption is non-transferable. Each application is specific to the individual and the vehicle listed on the form.

  7. What happens if the exemption is denied?

    If the application is denied, the reasons for denial will be provided. Applicants may need to address the concerns raised or seek further medical documentation before reapplying.

Common mistakes

When individuals complete the Louisiana Window Tint Exemption Sticker form, they often encounter several common mistakes that can lead to delays or denials. Understanding these pitfalls can facilitate a smoother application process.

One frequent error is failing to provide complete personal information. Applicants must ensure that their full name, driver’s license number, date of birth, and contact information are accurately filled in. Incomplete or incorrect details may result in the application being rejected outright.

Another common mistake involves the vehicle information section. Individuals must accurately list the year, make, model, and vehicle identification number. Omitting any of these details or providing incorrect information can create complications in verifying ownership and may lead to a denial of the exemption.

Applicants sometimes overlook the requirement to declare their relationship to the vehicle. The form stipulates that the affiant must be the registered owner, spouse, or immediate family member with significant use of the vehicle. Failing to clarify this relationship can raise questions about eligibility.

Additionally, individuals may not provide sufficient medical justification for the exemption. The form requires a detailed description of the medical condition that necessitates the exemption. A vague or incomplete explanation may not satisfy the criteria set forth under L.R.S. 32:361.2, leading to disapproval.

Some applicants neglect to check for prior convictions related to drug offenses or violent crimes. The form requires an affirmation that the affiant has not been convicted of such offenses. Failing to disclose this information may result in a denial and can have legal implications.

Another mistake occurs when applicants do not secure the necessary signatures. The form must be signed by both the affiant and a notary public. Without these signatures, the application is considered incomplete and invalid.

Moreover, individuals sometimes misinterpret the validity period of the exemption. The exemption is valid for three years unless the owner is 60 years or older, in which case it remains valid for the duration of ownership. Misunderstanding this provision can lead to unnecessary reapplications.

Lastly, applicants may forget to include the original certificate in their vehicle. The exemption is void if altered or falsified, and the original must be carried at all times. This oversight can result in legal complications if stopped by law enforcement.

By being aware of these common mistakes, individuals can improve their chances of successfully obtaining the Louisiana Window Tint Exemption Sticker and ensure compliance with state regulations.

Documents used along the form

The Louisiana Window Tint Exemption Sticker form is an essential document for individuals seeking a medical exemption for window tinting regulations. However, there are several other forms and documents that may be necessary to accompany this application or to address related issues. Below is a list of these documents, each briefly described to provide clarity on their purpose and importance.

  • Medical Certification Form: This document is completed by a licensed physician or optometrist. It certifies that the individual has a medical condition that necessitates the use of window tint beyond the legal limits. The form often includes details about the specific medical condition and the reasons why standard sunglasses are insufficient.
  • Proof of Vehicle Ownership: This document can be a vehicle registration or title that verifies the applicant is the registered owner of the vehicle. It ensures that the exemption is being applied for the correct vehicle.
  • Identification Documents: A valid driver’s license or state-issued ID is required to confirm the identity of the applicant. This helps to establish that the individual applying for the exemption is who they claim to be.
  • Application for Vehicle Modification: Some jurisdictions may require an additional application if modifications to the vehicle, such as window tinting, are being made. This document outlines the nature of the modifications and may require approval from local authorities.
  • Criminal History Consent Form: As part of the exemption process, applicants may need to consent to a background check. This form allows the relevant authorities to verify that the applicant has no disqualifying criminal history.
  • Notarized Affidavit: Some applications may require a notarized statement affirming the truthfulness of the information provided. This adds an extra layer of verification to the application process.
  • Insurance Documentation: Proof of insurance for the vehicle may be necessary to demonstrate that the vehicle is legally insured, which is often a requirement for any modifications made.
  • Medical Records Release Form: This form allows the Louisiana State Police or other authorities to access medical records relevant to the exemption request. It ensures that the necessary medical information can be reviewed without violating privacy laws.
  • Renewal Application: If the exemption is set to expire, a renewal application may be needed to continue the exemption. This document typically requires updated medical certification and proof of ongoing eligibility.
  • Appeal Form: In cases where an exemption request is denied, an appeal form allows the applicant to contest the decision. This document outlines the reasons for the appeal and may require additional supporting documentation.

Each of these documents plays a crucial role in ensuring that the window tint exemption process is thorough and compliant with state regulations. It is important for applicants to gather all necessary paperwork to facilitate a smooth application process. By being prepared, individuals can better navigate the requirements and advocate for their needs effectively.

Similar forms

The Louisiana Window Tint Exemption Sticker form serves a specific purpose, allowing individuals with certain medical conditions to legally tint their vehicle windows beyond standard regulations. Several other documents share similarities with this form, particularly in their function of providing exemptions or certifications based on specific criteria. Here are four such documents:

  • Medical Marijuana Patient Registry Card: Similar to the Window Tint Exemption form, this card is issued to individuals who meet specific medical criteria. It allows patients to legally possess and use medical marijuana, providing an official recognition of their medical condition.
  • Disability Parking Permit: This permit is granted to individuals with disabilities, allowing them to park in designated spaces. Like the Window Tint Exemption, it requires proof of a medical condition and is intended to provide necessary accommodations for those in need.
  • Hunting and Fishing License for Disabled Persons: This license offers exemptions and special privileges to individuals with disabilities, enabling them to hunt and fish in ways that accommodate their conditions. It parallels the Window Tint Exemption in that it recognizes specific needs and grants official permissions.
  • Special Needs School Transportation Form: This form allows for the transportation of children with special needs, ensuring they receive appropriate services. It, too, is similar in that it requires documentation of a medical condition and aims to provide necessary support for individuals facing unique challenges.

Each of these documents underscores the importance of recognizing individual needs and providing appropriate accommodations, just as the Louisiana Window Tint Exemption Sticker does for those with medical conditions requiring sun-screening materials in their vehicles.

Dos and Don'ts

When filling out the Louisiana Window Tint Exemption Sticker form, it is essential to follow specific guidelines to ensure that the application is completed correctly. Below is a list of things to do and avoid during this process.

  • Do provide accurate and complete information in all fields, including your full name, driver's license number, and vehicle details.
  • Do ensure that the medical condition justifying the exemption is clearly stated and supported by a physician's statement.
  • Do sign the affidavit in the designated area to certify that the information provided is true and accurate.
  • Do keep a copy of the completed form for your records before submitting it.
  • Do consult with a physician to ensure that all medical documentation meets the requirements outlined in the form.
  • Don't leave any sections blank; incomplete forms may lead to delays or denials.
  • Don't alter or falsify any information on the form, as this can result in legal consequences.
  • Don't forget to include the physician's signature and contact information, as this is crucial for the approval process.
  • Don't assume that previous exemptions will automatically apply; each application must be evaluated on its own merits.

By adhering to these guidelines, individuals can help facilitate a smoother application process for the Louisiana Window Tint Exemption Sticker.

Misconceptions

  • Misconception 1: The exemption sticker can be transferred between vehicles.
  • This is not true. The medical exemption is non-transferable and is specific to the vehicle registered under the owner's name. If you change vehicles, you will need to apply for a new exemption.

  • Misconception 2: Any level of tint is allowed with the exemption sticker.
  • While the exemption allows for darker tints than typically permitted, there are still limits. For example, the legal maximum for the front side windows is 40% light transmission.

  • Misconception 3: The exemption lasts indefinitely.
  • This is a common misunderstanding. The medical exemption is valid for three years from the date of issuance, unless you are over 60 years old, in which case it lasts for the duration of ownership.

  • Misconception 4: A simple note from a doctor is sufficient for the exemption.
  • It’s not that simple. A detailed medical affidavit must be completed by a licensed physician, clearly explaining the medical condition and why the exemption is necessary.

  • Misconception 5: The exemption sticker can be used by anyone in the family.
  • The exemption is only valid for the registered owner, their spouse, or immediate family members who have significant use of the vehicle. It does not apply to all family members.

  • Misconception 6: There are no penalties for falsifying information on the application.
  • Falsifying information is a serious offense. The affidavit must be accurate, and providing false information can lead to legal consequences.

  • Misconception 7: The exemption applies to all windows on the vehicle.
  • The exemption primarily applies to the windshield and front side windows. There are specific regulations regarding the rear windows that must be followed.

  • Misconception 8: You can drive without carrying the original exemption certificate.
  • This is incorrect. The original certificate must be carried in the vehicle at all times. If it is not present, the exemption is considered void.

Key takeaways

  • Complete the form accurately, providing your full name, driver's license number, date of birth, and contact information.

  • Ensure that the vehicle information is correct, including the year, make, model, and vehicle identification number (VIN).

  • Indicate valid medical reasons for the exemption, referencing the specific conditions recognized by the World Health Organization.

  • Obtain a physician's signature to validate the medical necessity for the exemption. This is crucial for approval.

  • Remember that the exemption is non-transferable and expires three years from the date of issuance.

  • Carry the original certificate in your vehicle at all times, as it will be void if altered or falsified.

  • Understand that the Louisiana State Police may review your medical records as part of the exemption process.