Homepage Free Louisiana Window Tint Exemption Sticker Template
Structure

In the warm and sun-drenched state of Louisiana, drivers seeking relief from the potentially harmful effects of the sun's rays on their health have a recourse through the Louisiana Window Tint Medical Exemption Affidavit. This document offers a structured pathway for individuals to legally apply window tinting beyond the standard light transmission limits set by state law, specifically aimed at those who, for medical reasons, require additional protection from sunlight. The affidavit details require the applicant to furnish comprehensive vehicle information, along with personal identification and a declaration underscoring the medical necessity for the exemption, validated by a physician's or optometrist's certification of the condition warranting such need, such as albinism, lupus, or photophobia among others listed by the World Health Organization International Classification of Disease. Notably, this exemption caters primarily to the vehicle's registered owner or their immediate families, emphasizing its non-transferable nature and a validity that adjusts with the owner's age—offering a longer duration for those 60 years and older. Moreover, the document underlines the importance of carrying the original certificate in the vehicle at all times, with a clear warning against alteration or falsification, which would render it void. Furthermore, applicants are reassured of their privacy and procedural fairness, as the document grants the Louisiana State Police the authority to conduct criminal history inquiries and to access relevant medical records, ensuring that the exemption is granted based on stringent criteria and genuine necessity.

Form Example

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

Document Breakdown

# Fact
1 The form is required for obtaining a window tint medical exemption in Louisiana.
2 It must be filed with LSP (Louisiana State Police).
3 Governing law for the form is L.R.S. 32:361.2.
4 The exemption allows for sun-screening materials that otherwise violate Louisiana's standard window tint laws.
5 Exemptions are based on valid medical reasons listed under the World Health Organization International Classification of Diseases (ICD-9-CM).
6 The exemption is valid for three years unless the vehicle owner is 60 years of age or older, in which case it lasts for the duration of the vehicle's ownership.
7 A criminal history inquiry and access to related medical records are authorized by the applicant through this form.
8 The form includes a section for the physician or optometrist to detail the qualifying medical condition.
9 Legal limits for non-exempt window tinting on passenger cars are 40% light transmission for front side windows, 25% for rear side windows, and 12% for the rear windshield.
10 The original certificate of the medical exemption must be carried in the vehicle at all times and is void if altered or falsified.

Instructions on Filling in Louisiana Window Tint Exemption Sticker

The process of applying for a Louisiana Window Tint Medical Exemption Sticker requires careful assemblage of accurate information and eligibility verification based on medical needs. This exemption is specific to the requirements of Louisiana State Police and the parameters set within the state laws, ensuring that individuals with certain medical conditions can maintain their safety and well-being while driving. Following the steps closely is critical to ensure the application is filled out correctly and approved.

  1. Enter the parish in Louisiana where the request is being made at the top of the form.
  2. Fill out the FULL NAME, DRIVER’S LICENSE NUMBER, and DATE OF BIRTH fields with the applicant's information.
  3. Provide the ADDRESS, including city, state, and ZIP code, and a contact (AREA CODE) PHONE NUMBER.
  4. In the Vehicle Information section, input the YEAR, MAKE, MODEL, VEHICLE IDENTIFICATION NO., and LICENSE PLATE of the car that needs the tint exemption.
  5. Confirm the statement regarding the affiant's relationship to the vehicle by checking the appropriate declaration.
  6. Indicate the valid medical reasons for the exemption by selecting from the list provided (i.e., albinism, lupus, porphyria, photophobia, etc.) and provide a detailed description of the condition under "DESCRIBE".
  7. Assert that you have not been convicted of any drug offense or violent crime, and authorize the Department to perform a criminal history inquiry and grant the Louisiana State Police access to all relevant medical records.
  8. If applicable, acknowledge the duration of the exemption based on ownership and age status, understanding that the exemption will remain valid for owners 60 years or older for the duration of vehicle ownership.
  9. Sign and date the form under SIGNATURE OF AFFIANT and have it witnessed and sealed by a notary public, including the NOTARY PUBLIC's signature, SEAL / NOTARY NUMBER, LSP Certificate Number.
  10. At the bottom, for an official optometrist or physician’s use only, ensure the medical professional completes the patient's information, including detailed explanations for the need for tint exemption, prints their name, signs, and dates the form, including their phone number.
  11. Finally, acknowledge that the application and medical exemption are subject to approval or disapproval by the Deputy Secretary, Public Safety Services, and/or Medical Advisory Board. Note that this decision will be documented on the form itself by the reviewing authorities.

Upon completion, the application is ready for submission to the relevant state authorities. Keep in mind, the original certificate must be kept in the vehicle at all times, and the exemption is non-transferable, expiring three years from the date of issuance unless specified otherwise due to the age and ownership conditions mentioned.

Listed Questions and Answers

What is the Louisiana Window Tint Medical Exemption Affidavit?

The Louisiana Window Tint Medical Exemption Affidavit allows individuals with certain medical conditions to apply for an exemption that permits them to equip their vehicle with window tint that exceeds the standard legal limits. This affidavit is necessary for those who require protection from sunlight due to medical reasons, as outlined by Louisiana Revised Statutes (L.R.S.) 32:361.2.

Who is eligible for a Window Tint Medical Exemption in Louisiana?

Eligibility for a window tint medical exemption is granted to individuals who suffer from specific medical conditions that necessitate protection from sunlight, including but not limited to albinism, lupus, porphyria, and photophobia. The applicant must also be the registered owner of the vehicle, or a spouse or immediate family member who frequently uses the said vehicle.

How can one apply for this exemption?

To apply for a window tint medical exemption, the individual must complete the affidavit and provide detailed information about the medical condition that requires this exemption. This includes having a licensed physician or optometrist fill out the relevant section of the form, detailing the medical necessity for tinted windows. The completed form then needs to be submitted to the Louisiana State Police for approval.

What medical conditions qualify for this exemption?

  • Albinism
  • Lupus
  • Porphyria
  • Photophobia
  • Other conditions recognized by the World Health Organization International Classification of Disease (ICD-9-CM) that require sun protection

Is the exemption permanent?

No, the exemption is not permanent. It expires three years from the date of issuance, except for individuals who are 60 years of age or older. In such cases, the exemption remains valid for the duration of the individual’s ownership of the vehicle, unless otherwise determined by the Department.

What happens after applying?

Upon receiving your application, the Louisiana State Police may consult with the Medical Advisory Board to determine if the exemption should be granted. Approval or denial is based on the information provided by the applicant and their physician. The applicant will be notified of the decision.

Are there any conditions under which the exemption could be denied?

Yes, the exemption could be denied if the application does not sufficiently demonstrate a medical necessity for the window tint, or if the applicant has been convicted of certain drug offenses or violent crimes. Additionally, falsification of the affidavit or failure to meet the specified medical conditions can also result in denial.

Can the exemption be transferred to another vehicle?

No, the exemption is non-transferable. It is specific to the vehicle listed in the approved affidavit and to the individual to whom it was granted. If the exempted individual acquires a new vehicle, a new application process must be undertaken.

What if the exempted individual turns 60 after receiving the exemption?

If the individual turns 60 years old after the exemption has been granted, the exemption will automatically extend for the duration of the individual's ownership of the vehicle, in accordance with L.R.S. 32:361.2(A)(3)(c).

What documentation is required to apply?

  1. Fully completed Window Tint Medical Exemption Affidavit.
  2. A detailed description of the medical condition from a licensed physician or optometrist.
  3. A copy of the vehicle registration showing the applicant as the registered owner or relative.

Common mistakes

Filling out the Louisiana Window Tint Exemption Sticker form is an important process for those seeking a medical exemption for window tint laws in Louisiana. It's crucial that this form is completed correctly to avoid delays or denial of the exemption. Below are common mistakes that individuals tend to make when filling out this form:

  1. Not providing complete personal information, such as leaving out the full name or driver’s license number. This information is critical for identifying the applicant.
  2. Failing to accurately describe the vehicle information, including the year, make, model, vehicle identification number (VIN), and license plate number, which are all necessary for the application to be processed.
  3. Skipping the section that requires the applicant to declare their relationship to the vehicle (registered owner, spouse, or immediate family member) and their significant use of it.
  4. Omitting details about the medical condition that necessitates the window tint. It's important to clearly indicate the medical reasons for the exemption.
  5. Not obtaining or including the necessary signature from a physician or optometrist, which is essential to verify the medical necessity of the window tint exemption.
  6. Forgetting to sign and date the affidavit section, which attests to the truthfulness and accuracy of the information provided in the form.
  7. Overlooking the requirement for the form to be notarized. The notary section must be completed to validate the affidavit.
  8. Assuming that the exemption applies across all states. It's important to remember that this exemption is specific to Louisiana and may not be recognized elsewhere. Additionally, the exemption is non-transferable and is subject to expiration or renewal conditions.

By avoiding these common errors, applicants can ensure their Louisiana Window Tint Exemption Sticker form is filled out correctly and that their application process is smooth. Paying close attention to the details and requirements outlined in the form is crucial for a successful exemption request.

Documents used along the form

When applying for a Louisiana Window Tint Medical Exemption, applicants often need to compile a variety of documents to support their application. These documents serve not only to fulfill the requirements set forth by the Louisiana State Police but also to ensure a smooth and efficient processing of the exemption request. The following list elaborates on the most common forms and documents that are typically used alongside the Louisiana Window Tint Exemption Sticker form.

  1. Proof of Residency: A document such as a utility bill or lease agreement verifying the applicant's Louisiana residence.
  2. Vehicle Registration: A copy of the current vehicle registration for the car receiving the window tint exemption.
  3. Physician’s Statement: A detailed statement from a licensed physician outlining the medical necessity for the window tint, referencing the specific condition(s) as per the provided form instructions.
  4. Photographic Identification: A valid government-issued ID (e.g., driver’s license) to confirm the applicant's identity.
  5. Application for Vehicle Inspection Waiver (if applicable): Required for vehicles that cannot pass the regular inspection due to the medically necessary window tint.
  6. Medical Records: Relevant medical records that further substantiate the medical necessity for the exemption.
  7. Proof of Age: For applicants claiming exemption eligibility based on age, a birth certificate or other official document proving the applicant is 60 years or older.
  8. Legal Documentation for Guardians: If the applicant is acting on behalf of an eligible minor or adult under guardianship, legal documents verifying this status are required.
  9. Criminal History Disclosure Form: A signed document where the applicant discloses any criminal history as per the form's declaration section.

It is important for applicants to carefully gather and review all necessary documents before submission to ensure a seamless exemption process. Understanding and adhering to the guidelines and requirements for each document will significantly contribute to a successful application. Always consult the latest state guidelines or seek advice from professional services when in doubt to ensure all prerequisites are met accurately and the application proceeds without unnecessary delays.

Similar forms

The Louisiana Window Tint Exemption Sticker form is similar to the California Vehicle Window Tint Medical Exemption Request. Like Louisiana’s, California's form also requires that individuals provide detailed medical justification for exceeding the state’s standard window tinting regulations. This includes the necessity for specific tint levels due to medical conditions that can be exacerbated by sunlight, such as lupus or photophobia. Both forms mandate personal identification details, vehicle information, and comprehensive descriptions of the medical condition warranting the exemption. Additionally, they both require a physician or optometrist’s validation of the medical need for the exemption. The primary aim of these documents is to ensure that individuals with legitimate health concerns can legally use darker window tints for protection against harmful UV rays, while maintaining compliance with state laws.

Furthermore, the Louisiana Window Tint Exemption Sticker form shares similarities with the Arizona Department of Transportation Medical Review Program Application. In Arizona, individuals seeking exemption from standard vehicle operation laws due to medical conditions must provide detailed medical information, similar to Louisiana's requirement for window tint exemptions. Both forms necessitate a statement from a licensed medical professional to validate the medical condition and its necessity for an exemption. The forms are designed with public safety in mind, aiming to accommodate individuals’ health needs without compromising on-road visibility standards. Despite serving different purposes—one for window tint and the other for broader vehicle operation conditions—both forms underline the importance of supporting residents with health-related needs in adhering to state regulations.

Comparatively, the Texas Department of Public Safety’s Application for Window Tint Exemption also mirrors the structure and requirements of Louisiana’s form. Texas residents suffering from medical conditions that require protection from direct sunlight are similarly required to submit detailed personal, vehicle, and medical condition information, alongside a certification from a healthcare professional. Both the Texas and Louisiana forms emphasize the requirement for an official seal or notary to validate the authenticity of the medical professional's signature, reinforcing the verification process. These procedures ensure that exemptions are granted based on genuine need, reflecting a careful balance between individual health requirements and adherence to state legal standards for window tinting.

Dos and Don'ts

When filling out the Louisiana Window Tint Exemption Sticker form, there are several guidelines you should follow to ensure your application is completed correctly and efficiently. Here are things you should do:

  • Double-check your personal and vehicle information for accuracy. Ensure that your full name, driver's license number, date of birth, and all vehicle information matches the official documents.
  • Clearly describe the medical condition. It's crucial to provide a detailed explanation in the section reserved for the optometrist or physician's use that supports the need for a window tint medical exemption.
  • Include the original certificate in your vehicle at all times. This document must be carried within the vehicle it pertains to, as per the requirements.
  • Ensure the form is signed and dated by both the affiant and a notary public. This step verifies the form's legitimacy and is a mandatory part of the application process.

Conversely, avoid these common mistakes to prevent delays or denial of your application:

  • Do not leave any fields blank. Incomplete forms may result in automatic denial. Ensure every section is filled out thoroughly.
  • Avoid any alterations or falsifications. Modifying or providing untrue information on the form will void the exemption certificate and could lead to legal consequences.
  • Do not ignore the legal light transmission percentages. Be familiar with L.R.S. 32:361.1 and ensure your request aligns with the exemptions allowed under L.R.S. 32:361.2.
  • Do not submit the application without the medical condition correctly indicated and described. Failing to properly indicate and describe the qualifying medical condition could result in the denial of your exemption request.

Misconceptions

Understanding the Louisiana Window Tint Medical Exemption process involves navigating through detailed legal and medical requirements. Misconceptions about the exemption often lead to confusion, misunderstandings, and sometimes, non-compliance. Here are eight common misconceptions about the Louisiana Window Tint Exemption Sticker form and the truths behind them:

  • Misconception 1: Anyone can get a window tint exemption for their vehicle if they simply don't like the sun. The reality is that exemptions are specifically for individuals with valid medical reasons that make it necessary to equip their vehicle with sun-screening material beyond the legal limit.
  • Misconception 2: The exemption is permanent. Actually, the medical exemption is valid for a period of not more than three years unless you are 60 years or older, in which case it lasts for the duration of your ownership of the vehicle.
  • Misconception 3: You can transfer the exemption to a new vehicle if you sell your old one. This medical exemption is non-transferable. A new application is required for each vehicle, even if the owner remains the same.
  • Misconception 4: Any health condition qualifies for an exemption. Only specific health conditions recognized by the World Health Organization International Classification of Disease ICD-9-CM, such as Albinoism, Lupus, Porphyria, and conditions leading to severe photophobia, qualify for a medical exemption.
  • Misconception 5: Sunglasses are not considered adequate protection by the state. In the physician's section of the form, it's required to explain why sunglasses wouldn’t be adequate for the patient's condition, implying that in some cases, sunglasses might be considered adequate protection, and thus, an exemption may not be granted.
  • Misconception 6: The affidavit doesn't need to be with you at all times. The law requires that the original certificate must be carried in the vehicle at all times to prove exemption validity when requested by law enforcement or other authorities.
  • Misconception 7: The exemption allows for any level of tint. Despite the exemption, there may still be restrictions on exactly how dark the window tinting can be. It allows for window tinting that might not meet the standard legal requirements, but it doesn't permit blackout tints or similar extreme modifications.
  • Misconception 8: A physician’s signature is all that's needed for approval. While a physician or optometrist’s signature is crucial, the Louisiana State Police and potentially the Medical Advisory Board review each application. Final approval is at their discretion, and they may deny the exemption for various reasons.

Clarifying these misconceptions is essential for all parties involved, from the vehicle owners applying for an exemption to the medical professionals and law enforcement officials. Understanding the specifics ensures that the process is followed correctly and that exemptions are granted appropriately, based on medical need and legal guidelines.

Key takeaways

Understanding the Louisiana Window Tint Medical Exemption process is crucial for anyone in need of this accommodation due to medical conditions. Here are some vital takeaways to make navigating the application easier:

  • The exemption allows the application of tint on the windshield up to six inches from the top, differing from standard legal limits.
  • Applicants must declare their relationship to the vehicle, asserting they are either the registered owner, spouse, or significant user of the vehicle in question.
  • Valid medical reasons must be present and detailed on the form; these should align with the conditions recognized by the Louisiana State Police, such as albinism, lupus, porphyria, or a condition that causes photophobia.
  • The exemption is specifically non-transferable and is valid for three years from the issuance date unless the vehicle owner is 60 years or older, in which case it lasts for the duration of their ownership.
  • Applicants must corroborate their medical condition with a physician or optometrist, who is required to detail the necessity of the exemption and affirm that standard sunglasses would not provide adequate protection.
  • It's important to carry the original exemption certificate in the vehicle at all times, and altering or falsifying this document will render it void.

These points highlight the importance of transparency, medical necessity, and correctness in applying for a Louisiana Window Tint Medical Exemption. Adhering to these requirements ensures compliance with the law while accommodating those with valid medical conditions.

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