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The Louisiana Window Tint Exemption Sticker form serves an important purpose for individuals who require medical exemptions for window tinting on their vehicles. This form allows registered vehicle owners or their immediate family members to apply for a medical exemption that permits the installation of sun-screening material that would otherwise violate state regulations. The form requires detailed information, including the applicant's full name, driver's license number, date of birth, and vehicle details such as make, model, and identification number. Applicants must declare their ownership status and provide valid medical reasons for the exemption, as outlined in Louisiana Revised Statutes. A physician's endorsement is necessary, detailing the specific medical condition and justifying the need for the exemption. This exemption is non-transferable and typically expires three years after issuance, although it can remain valid for the duration of ownership for individuals aged 60 and older. The form also includes a section for notary verification and requires the applicant to affirm the truthfulness of their statements under penalty of law. Adhering to these guidelines is essential for ensuring compliance with Louisiana's window tinting laws.

Document 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

Dos and Don'ts

When filling out the Louisiana Window Tint Exemption Sticker form, it is important to follow specific guidelines to ensure the process goes smoothly. Below is a list of things to do and not to do.

  • Do provide accurate personal information, including your full name, driver's license number, and date of birth.
  • Do ensure that the vehicle information is complete, including the make, model, and vehicle identification number.
  • Do declare your medical condition clearly and provide necessary details as required by the form.
  • Do have your physician or optometrist complete their section accurately, including their signature and date.
  • Don't submit the form without a notary public's signature if required.
  • Don't alter or falsify any information on the form, as this will void the exemption.
  • Don't forget to keep the original certificate in the vehicle at all times once approved.

Detailed Instructions for Filling Out Louisiana Window Tint Exemption Sticker

Completing the Louisiana Window Tint Exemption Sticker form involves several key steps to ensure accuracy and compliance with state regulations. This process requires personal information, vehicle details, and medical justification for the exemption. Follow the steps below to fill out the form correctly.

  1. Begin by entering the parish where you reside at the top of the form.
  2. Provide your full name as it appears on your driver's license.
  3. Input your driver’s license number.
  4. Fill in your date of birth.
  5. Enter your address, including city, state, and zip code.
  6. Provide your phone number with area code.
  7. Include the year, make, and model of your vehicle.
  8. Fill in the Vehicle Identification Number (VIN) and license plate number.
  9. Confirm that you are the registered owner or a family member with significant use of the vehicle by checking the appropriate box.
  10. Indicate the valid medical reasons for the exemption in the designated area.
  11. Sign and date the form at the bottom where it states SIGNATURE OF AFFIANT.
  12. Have the form notarized by a notary public who will also provide their seal and number.
  13. Ensure that the physician or optometrist completes the section regarding the medical condition and signs it.
  14. Keep the original certificate in your vehicle at all times once approved.

After completing the form, submit it to the Louisiana State Police for review. They will assess the application and determine whether to grant the exemption. It’s essential to retain a copy of the completed form for your records, as well as the original certificate once issued, as it must be carried in the vehicle at all times.

Documents used along the form

When applying for the Louisiana Window Tint Exemption Sticker, several other forms and documents may be required to support your application. Each of these documents serves a specific purpose in ensuring compliance with state regulations and verifying medical necessity. Below is a list of commonly associated documents.

  • Medical Records: These documents provide evidence of the medical condition that necessitates the window tint exemption. They may include diagnosis reports or treatment summaries from your healthcare provider.
  • Physician’s Statement: A written statement from your doctor detailing your medical condition and explaining why standard sunglasses are insufficient for protection. This statement should be signed and dated.
  • Proof of Vehicle Ownership: Documentation such as a vehicle title or registration that confirms you are the registered owner of the vehicle for which the exemption is being requested.
  • Identification: A government-issued ID, such as a driver’s license, that verifies your identity and matches the name on your application.
  • Application for Medical Exemption: This is the formal application form that outlines your request for a window tint exemption based on medical grounds. It must be filled out completely and accurately.
  • Notarized Affidavit: A sworn statement affirming the truthfulness of the information provided in your application, often requiring a notary public’s signature.
  • Criminal Background Check Consent: A form allowing the Louisiana State Police to conduct a background check to ensure eligibility for the exemption.
  • Insurance Information: Proof of auto insurance may be required to confirm that the vehicle is covered under a valid policy.
  • Motor Vehicle Bill of Sale: Essential for documenting the transfer of ownership when selling or purchasing a vehicle. For a structured format, consider using the Fast PDF Templates to ensure all necessary details are included.
  • Renewal Application: If your exemption is nearing expiration, you may need to submit a renewal application along with updated medical documentation.

Gathering these documents can streamline the process of obtaining your window tint exemption. Ensure that all information is accurate and complete to avoid delays. If you have questions about specific requirements, it may be beneficial to consult with a professional who can provide guidance tailored to your situation.

Your Questions, Answered

What is the Louisiana Window Tint Exemption Sticker form?

The Louisiana Window Tint Exemption Sticker form is an official document that allows individuals with specific medical conditions to legally have darker window tint on their vehicles than normally permitted by state law. This exemption is particularly important for those whose medical conditions require additional protection from sunlight, which standard window tints may not provide. The form must be completed and approved by the Louisiana State Police and includes sections for personal and vehicle information, as well as medical documentation from a licensed physician.

Who is eligible to apply for the exemption?

Eligibility for the Louisiana Window Tint Exemption is primarily based on medical necessity. Individuals with certain conditions, such as albinism, lupus, porphyria, or photophobia, may qualify. Additionally, the applicant must be the registered owner of the vehicle or a spouse or immediate family member with significant use of the vehicle. It is also important that the applicant has not been convicted of any drug offenses or violent crimes, as this may affect their eligibility.

How long is the exemption valid?

The exemption is 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. It is crucial to keep the original certificate in the vehicle at all times, as it is not valid if altered or falsified.

What information is required on the application form?

The application form requires several key pieces of information:

  1. Full name, driver's license number, and date of birth of the applicant.
  2. Complete address, including city, state, and zip code.
  3. Vehicle information, including year, make, model, vehicle identification number (VIN), and license plate number.
  4. A detailed description of the medical condition that necessitates the exemption, along with supporting documentation from a physician.

What happens after the application is submitted?

Once the application is submitted, the Louisiana State Police will review the information provided. They may consult the Medical Advisory Board to assess the medical necessity of the exemption. If approved, the exemption sticker will be issued, allowing the applicant to legally have the specified window tint on their vehicle. If denied, the applicant will receive a reason for the denial.

Can the exemption be transferred to another vehicle?

No, the Louisiana Window Tint Medical Exemption is non-transferable. Each vehicle must have its own exemption sticker, and the sticker is only valid for the vehicle listed on the application. If a person changes vehicles, they must reapply for a new exemption for the new vehicle.

Common mistakes

Filling out the Louisiana Window Tint Exemption Sticker form can be straightforward, but several common mistakes can lead to delays or denials. One frequent error occurs when applicants fail to provide complete personal information. The form requires the full name, driver’s license number, date of birth, and contact details. Omitting any of this information can result in the application being returned for correction.

Another mistake involves the vehicle information section. Applicants sometimes neglect to accurately fill in details such as the year, make, model, and vehicle identification number (VIN). Providing incorrect or incomplete vehicle information may lead to complications, as the exemption is tied directly to the specific vehicle listed on the form.

In addition, applicants often misunderstand the medical justification required for the exemption. The form asks for a detailed description of the medical condition that necessitates the window tint. Failing to provide sufficient details or clarity can lead to the application being denied. It is essential to explain why standard sunglasses are inadequate for protection, particularly for conditions like photophobia.

Lastly, individuals frequently overlook the signature requirement. The form must be signed by the affiant and a notary public. Not providing a signature or having an unsigned notary section can invalidate the application. Ensuring all signatures are complete and that the notary section is properly filled out is crucial for a successful submission.

Misconceptions

Understanding the Louisiana Window Tint Exemption Sticker can be crucial for those who need it for medical reasons. However, several misconceptions can lead to confusion. Here’s a look at some of the most common misunderstandings.

  • Anyone can get a window tint exemption. This is not true. Only individuals with specific medical conditions, such as lupus or photophobia, can qualify for this exemption.
  • The exemption is permanent. The exemption is valid for a maximum of three years unless the vehicle owner is over 60 years old, in which case it lasts for the duration of ownership.
  • There is no need for a doctor's note. A physician must provide a detailed explanation of the medical condition to support the exemption request. This is a critical part of the application process.
  • Once approved, the exemption sticker can be transferred to another vehicle. The exemption is non-transferable and applies only to the specific vehicle for which it was issued.
  • All types of window tint are allowed. There are specific legal limits for window tinting. For example, front side windows must allow 40% light transmission, while the rear side windows can allow only 25%.
  • It’s okay to alter the exemption certificate. Altering or falsifying the certificate will void it. The original certificate must be carried in the vehicle at all times.
  • Approval is guaranteed once the application is submitted. The Louisiana State Police, along with the Medical Advisory Board, reviews applications, and approval is not guaranteed.
  • Having sunglasses is sufficient for protection. The exemption is specifically for individuals whose medical conditions require more than standard sunglasses for protection from sunlight.
  • There’s no need to inform law enforcement about the exemption. It’s essential to carry the exemption certificate in the vehicle and inform law enforcement if stopped, as it provides legal protection for the tinted windows.

Addressing these misconceptions can help ensure that individuals who truly need the exemption can obtain it without unnecessary complications. Always consult with a qualified professional to navigate the application process effectively.

Document Attributes

Fact Name Details
Governing Law The Louisiana Window Tint Medical Exemption is governed by L.R.S. 32:361.2 and L.R.S. 32:361.1.
Eligibility Criteria Applicants must have valid medical reasons for needing a window tint that does not meet standard light transmission requirements.
Duration of Validity The exemption is valid for three years unless the vehicle owner is 60 years or older, in which case it lasts for the duration of ownership.
Non-Transferability The medical exemption is non-transferable and must be carried in the vehicle at all times.
Application Process Affiants must complete an affidavit and may need to provide additional medical documentation to the Louisiana State Police.
Legal Limits Legal window tint limits are 40% light transmission for front side windows, 25% for rear side windows, and 12% for rear windshields.