OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES BMV USE ONLY CARD NO. APPLICATION FOR REPLACEMENT WINDSHIELD PLACARD DATE ISSUED WARNING: Applicant giving false information is subject to prosecution (Ohio Revised Code (R.C.) 2913.42.) (Please print or type) NAME OF DISABLED PERSON SOCIAL SECURITY NO. STREET ADDRESS CITY STATE ZIP CODE OH SIGNATURE OF DISABLED PERSON OR NEXT OF KIN AND RELATIONSHIP PHONE NO. ( Card was: Previous card no.: LOST ) STOLEN DAMAGED IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE GRATIS LICENSE PLATE UNIT AT 614-752-7518 OHIO BUREAU OF MOTOR VEHICLES ATTN: GRATIS UNIT P.O. BOX 16521 COLUMBUS OH 43216-6521 American LegalNet, Inc. www.FormsWorkflow.com BMV 4532 9/08 OHIO DEPARTMENT OF PUBLIC SAFETY BUREAU OF MOTOR VEHICLES BMV USE ONLY CARD NO. APPLICATION FOR REPLACEMENT WINDSHIELD PLACARD DATE ISSUED WARNING: Applicant giving false information is subject to prosecution (Ohio Revised Code (R.C.) 2913.42.) (Please print or type) NAME OF DISABLED PERSON SOCIAL SECURITY NO. STREET ADDRESS CITY STATE ZIP CODE OH SIGNATURE OF DISABLED PERSON OR NEXT OF KIN AND RELATIONSHIP PHONE NO. ( Previous card no.: Card was: LOST STOLEN ) DAMAGED IF YOU HAVE ANY QUESTIONS, PLEASE CALL THE GRATIS LICENSE PLATE UNIT AT 614-752-7518 OHIO BUREAU OF MOTOR VEHICLES ATTN: GRATIS UNIT P.O. BOX 16521 COLUMBUS OH 43216-6521 BMV 4532 9/08