Homepage Fill in a Valid New Jersey Mr 15 Template
Article Guide

The New Jersey MR-15 form plays a crucial role for individuals seeking medical exemptions for sun-screening materials on their vehicles. This form is specifically designed for those with certain medical conditions, such as polymorphous light eruption or lupus erythematosus, which require protection from harmful sunlight. To initiate the process, applicants must fill out the form in its entirety, including sections that require a physician’s input. Incomplete submissions may lead to rejection, so attention to detail is essential. The completed application does not automatically permit the use of sun-screening material; rather, it is a request that, upon approval, results in a Medical Exemption for Vehicle Sun-Screening Certificate. This certificate outlines the specific type of sun-screening material allowed and the vehicle windows it may be applied to. It’s important to note that all sun-screening materials must comply with New Jersey's tint regulations, which dictate where and how these materials can be applied. For instance, the windshield can only be treated above a certain line, and the materials must meet strict visibility standards. Additionally, if the vehicle is sold or the license plates are transferred, the certificate must be returned to the Motor Vehicle Commission. This process ensures that individuals who genuinely need sun protection can do so legally and safely, while also maintaining compliance with state regulations.

Example - New Jersey Mr 15 Form

New Jersey

Motor Vehicle Commission

STATE OF NEW JERSEY

Dear Applicant:

West Deptford Service Center

215 Crown Point Road

Suite100

West Deptford, New Jersey 08086

Information enclosed references legislation that allows sun-screening material for explicit medical reasons such as poly morphous eruption, persistent light reactivity, actinic reticuloid, porphyrins, solar urticaria, and lupus erythematosus.

To apply for sun-screening material, please complete the enclosed application and return to the Motor Vehicle Commission (MVC). The application is to be fully completed by you and your physician. Incomplete or missing information will be cause for rejection. This application does not grant you permission to have sun- screening material applied to your vehicle. All unauthorized sun-screening materials installed are subject to removal, fines and failure to pass New Jersey inspection. Upon sale of vehicle or transfer of license plates, you must return your Medical Exemption for Sun-Screening Certificate to the MVC.

Upon review and approval by MVC you will be issued a “Medical Exemption for Vehicle Sun-Screening Certificate”. This certificate will reflect the type of sun- screening material to be applied to a specific vehicle and windows. Applicants approved for sun-screening materials are responsible for removal of this material prior to the sale or transfer of the exempted vehicle.

You must adhere to the New Jersey tint regulation (N.J.A.C. 13:20-1.1-1.8) requirements listed below:

All medical sun-screening materials must be applied to the portion of the windshield above the AS-1 line. To reduce the transmittance of normally incident light reflection below 70%.

The sun-screening materials could be applied to the upper most portion of the front side window. To reduce visible light below 35%.

The sun-screening materials applied to the windshield or front side windows shall not exceed 8%.

All sun-screening materials applied must be of clear film.

Please visit the MVC Website www.state.nj.us/mvc/Licenses/sunscreening.htm for a list of licensed tinting facilities.

On the Road to Excellence

Visit us at www.njmvc.gov

New Jersey is an Equal Opportunity Employer

NEW JERSEY

MOTOR VEHICLE COMMISSION

West Deptford Regional Service Center

215 Crown Point Road, Suite 100

West Deptford, NJ 08086

REQUEST FOR MEDICAL EXEMPTION TO APPLY VEHICLE SUN-SCREENING

The following information is to be completed by the applicant. (Please print or type.)

Name:

 

 

 

 

Phone number: ________________________

Driver License No.:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address:

 

 

 

 

 

 

 

 

 

 

Street

City

 

 

State

Zip Code

Vehicle

 

 

 

 

 

 

 

 

Make

Model

Year

Plate No.

Vehicle Identification No.

The following information is to be completed by your physician. (Please print or type.)

Check the medical condition that may require the application of sun-screening material:

poly morphous light eruption

persistent light reactivity

actinic rectuloid

porphyrins

solar urticaria

lupus erythematosus

Description of Patient's condition requiring sun-screening:

Recommended treatment:

If the condition is dermatological, has photo testing been done to identify the action spectra or wavelength eliciting a

photo-sensitive medical condition?

Yes

No

If "Yes," what is the wavelength eliciting photosensitivity:__________ nm or;

If "No," what is the action spectra (UVA, UVB, near UV, visible):_________________________________

Physician Information

Name:

Business Address:

 

Street or P.O Box

 

City

State

Zip Code

Medical License No.:

 

State

 

Date of Licensure

 

I certify, under penalty of law, that the above facts are true and correct to the best of my knowledge.

Physician's Signature:

 

Date:

 

(When complete, return to the address above.)

MR-15 (R 6/09)

Form Specs

Fact Name Description
Governing Law The New Jersey tint regulation is governed by N.J.A.C. 13:20-1.1-1.8.
Application Requirement Applicants must complete the form in full, including information from their physician.
Medical Conditions Eligible conditions for sun-screening material include lupus erythematosus and solar urticaria.
Certificate Issuance Upon approval, a “Medical Exemption for Vehicle Sun-Screening Certificate” will be issued by the MVC.
Transfer of Vehicle Medical Exemption certificates must be returned to the MVC upon vehicle sale or plate transfer.
Please rate Fill in a Valid New Jersey Mr 15 Template Form
4.52
Exceptional
25 Votes