Fill in a Valid New Jersey Mr 15 Template
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
To apply for
Upon review and approval by MVC you will be issued a “Medical Exemption for Vehicle
You must adhere to the New Jersey tint regulation (N.J.A.C.
•All medical
•The
•The
•All
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
The following information is to be completed by the applicant. (Please print or type.)
Name: |
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Phone number: ________________________ |
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Driver License No.: |
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Address: |
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Street |
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Zip Code |
Vehicle |
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Make |
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Year |
Plate No. |
Vehicle Identification No. |
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The following information is to be completed by your physician. (Please print or type.)
Check the medical condition that may require the application of
poly morphous light eruption
persistent light reactivity
actinic rectuloid
porphyrins
solar urticaria
lupus erythematosus
Description of Patient's condition requiring
Recommended treatment:
If the condition is dermatological, has photo testing been done to identify the action spectra or wavelength eliciting a
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:
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Street or P.O Box |
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City |
State |
Zip Code |
Medical License No.: |
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State |
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Date of Licensure |
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I certify, under penalty of law, that the above facts are true and correct to the best of my knowledge.
Physician's Signature: |
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Date: |
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(When complete, return to the address above.)
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. |
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