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PAC OPEN SHOW AFFIDAVIT THIS REPORT MUST COVER ONE PONY×ONE RIDER ONLY Pony Name: Pony Sex: Registration No.: Year Foaled: Height: Riders Name: PHC: State: Riders Birthdate: Owners Name: State: Location
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How to fill out handicapped medallion nomination form

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How to fill out a handicapped medallion nomination form:

01
Obtain the form: Start by acquiring the handicapped medallion nomination form from the relevant authority or organization responsible for issuing these medallions. You can usually find these forms online on their website or request a physical copy.
02
Read the instructions: Before filling out the form, carefully read the instructions provided. This will guide you on how to properly complete the form and ensure that all required information is provided.
03
Personal information: Begin by providing your personal details, such as your full name, address, contact information, and any identification numbers required. Ensure that you provide accurate and up-to-date information to avoid any delays in processing.
04
Medical information: In this section, you will be asked to provide information about the individual who requires the handicapped medallion. This includes their name, age, medical condition, and any supporting documentation from a healthcare professional or specialist. Make sure to attach any necessary medical records or documentation as required by the form.
05
Justification: In this part of the form, you will need to explain why the individual needs a handicapped medallion. Provide a detailed explanation of the specific mobility challenges they face and how having this medallion would aid their ability to travel or park.
06
Supporting documents: Attach any additional supporting documents that might strengthen your nomination. This could include prescriptions, medical certificates, letters from healthcare professionals, or any other relevant documents that support the necessity of the handicapped medallion.
07
Signature and date: Sign and date the form to acknowledge that the information provided is true and accurate to the best of your knowledge.

Who needs a handicapped medallion nomination form?

01
Individuals with mobility impairments: People who have difficulty walking or moving due to physical disabilities, injuries, or medical conditions may require a handicapped medallion. This form is needed to nominate them for a medallion that allows easier access to designated parking spaces or other facilities.
02
Caregivers or guardians: If an individual with a mobility impairment is unable to fill out the form themselves, their caregiver or legal guardian can complete it on their behalf. The caregiver must provide accurate and detailed information about the person requiring the medallion.
03
Relevant authorities or organizations: Those responsible for issuing handicapped medallions, such as local government agencies, disability organizations, or medical institutions, may require a handicapped medallion nomination form in order to process the application and determine eligibility.
It is important to note that the exact process and requirements for filling out a handicapped medallion nomination form may vary depending on the jurisdiction or organization responsible for issuing these medallions. Therefore, it is advisable to follow the specific instructions provided on the form or contact the relevant authority for further guidance if needed.
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