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Fillable DOR - 1776 Physician's Statement for Disabled License Plates/Placard - dor mo

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Print MISSOURI DEPARTMENT OF REVENUE MOTOR VEHICLE BUREAU PO BOX 598, JEFFERSON CITY MO 65105-0598 (573) 526-3669 www.dor.mo.gov/mvdl Reset FORM PHYSICIAN'S STATEMENT FOR DISABLED LICENSE PLATES/PLACARD 1776 (REV. 08-2010) THIS STATEMENT IS ONLY VALID FOR 90 DAYS. TO BE COMPLETED BY A AN ADVANCE PRACTICE REGISTERED NURSE, LICENSED PHYSICIAN, CHIROPRACTOR, PHYSICIAN'S ASSISTANT, PODIATRIST OR OPTOMETRIST. IF...
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