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Louisiana Window Tint Exemption Sticker Form

The Louisiana Window Tint Exemption Sticker form is a document that allows individuals with specific medical conditions to legally apply darker window tinting to their vehicles beyond the standard limits. This exemption is particularly important for those whose health conditions necessitate additional protection from sunlight. Understanding the requirements and process for obtaining this exemption can help eligible drivers navigate the application successfully.

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The Louisiana Window Tint Exemption Sticker form is an important document for individuals seeking to legally tint their vehicle windows beyond the standard regulations due to medical conditions. This form allows registered vehicle owners, or their immediate family members, to apply for an exemption based on specific medical needs. The application requires detailed personal information, including the driver's license number, address, and vehicle details such as make, model, and identification number. Additionally, applicants must declare that they have valid medical reasons, as outlined in Louisiana Revised Statute 32:361.2, which necessitate the use of sun-screening material that would otherwise violate standard light transmission limits. The form also includes a section for medical professionals to specify the condition justifying the exemption, and it mandates that the applicant has not been convicted of drug offenses or violent crimes. The exemption is valid for three years but can extend for individuals aged 60 and older, allowing them to maintain their exemption as long as they own the vehicle. It is crucial for applicants to understand that the original certificate must be kept in the vehicle at all times and that any alterations will void the exemption. Overall, this form serves as a vital tool for those needing additional protection from sunlight due to medical conditions.

Louisiana Window Tint Exemption Sticker 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

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Documents used along the form

When applying for the Louisiana Window Tint Exemption Sticker, several other forms and documents may also be required or beneficial for your application process. These documents help ensure that all necessary information is provided and that your exemption is processed smoothly. Below is a list of commonly used forms and documents associated with the exemption.

Medical Documentation: A letter from your physician or optometrist detailing your medical condition. This letter should explain why standard sunglasses are insufficient and why window tint is necessary for your health.
Bill of Sale Document: To better secure your transaction, consider utilizing a New York Bill of Sale form, which can be accessed through legalpdf.org. This document provides proof of purchase and details on the item being sold, essential for transferring ownership smoothly.
Proof of Vehicle Ownership: A copy of your vehicle registration or title. This document verifies that you are the registered owner of the vehicle for which you are requesting the exemption.
Identification Documents: A government-issued photo ID, such as a driver’s license. This helps confirm your identity and age, which may be relevant for certain exemptions.
Affidavit of Family Member: If applicable, a notarized affidavit from a family member who regularly uses the vehicle. This document can support claims for exemptions based on shared vehicle use.
Application for Exemption: A formal application form that outlines your request for the window tint exemption. This form typically includes personal information and details about your medical condition.
Criminal Background Check Consent: A signed consent form allowing the Louisiana State Police to perform a background check. This is often required to ensure that the applicant has not been convicted of disqualifying offenses.
Renewal Application: If your exemption is expiring, a renewal application form will be necessary. This document helps to maintain your exemption status beyond the initial three-year period.

Gathering these documents can help streamline the process of obtaining your Louisiana Window Tint Exemption Sticker. Ensure that all information is accurate and complete to avoid delays. If you have questions about any specific requirements, seeking guidance from a knowledgeable source can be beneficial.

Key takeaways

When filling out the Louisiana Window Tint Exemption Sticker form, keep these key takeaways in mind:

Eligibility: You must be the registered owner, spouse, or immediate family member of the vehicle to apply.
Medical Justification: Valid medical reasons must be provided to justify the need for window tint that exceeds legal limits.
Criminal Background Check: Be aware that a criminal history inquiry will be conducted as part of the application process.
Duration of Validity: The exemption is valid for three years unless you are 60 years or older, in which case it lasts for the duration of vehicle ownership.
Original Certificate Requirement: Always carry the original certificate in your vehicle. It becomes void if altered or falsified.
Physician's Role: A licensed optometrist or physician must provide their signature and a detailed description of the medical condition.
Specific Conditions: The form lists specific conditions that may qualify for an exemption, such as albinism and lupus.
Approval Process: The Medical Advisory Board will review the application and determine approval or denial based on provided medical evidence.

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