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Official Louisiana Window Tint Exemption Sticker Template in PDF

The Louisiana Window Tint Exemption Sticker form allows individuals with specific medical conditions to legally use darker window tint on their vehicles. This exemption is particularly beneficial for those who require additional protection from sunlight due to health issues. If you believe you qualify, take the first step by filling out the form below.

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Structure

Document Overview

Fact Name	Details
Eligibility Criteria	To qualify for the exemption, the applicant must have a valid medical reason, which must be supported by a physician's statement.
Governing Law	The exemption is governed by Louisiana Revised Statutes L.R.S. 32:361.1 and L.R.S. 32:361.2.
Validity Period	The medical 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-Transferable	This medical exemption is non-transferable and must remain with the vehicle it was issued for.
Documentation Requirement	The original certificate must be carried in the vehicle at all times and is void if altered or falsified.

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Detailed Steps for Writing Louisiana Window Tint Exemption Sticker

Completing the Louisiana Window Tint Exemption Sticker form requires careful attention to detail. This process involves providing personal information, vehicle details, and medical justification for the exemption. Ensure that all sections are filled out accurately to avoid delays in processing.

Begin by entering your full name in the designated space at the top of the form.
Fill in your driver's license number and date of birth below your name.
Provide your complete address, including city, state, and ZIP code.
Enter your phone number, including the area code.
Next, provide the year, make, and model of your vehicle.
Fill in the Vehicle Identification Number (VIN) and license plate number.
In the section labeled "Affiant declares," confirm that you are the registered owner or an immediate family member with significant use of the vehicle.
Indicate the valid medical reasons for the exemption in the appropriate section of the form.
Sign and date the form where indicated to certify that the information provided is true and accurate.
Have the form notarized by a notary public, who will also place their seal and number on the document.
Ensure that the physician completes their section, including their name, signature, and phone number.
Finally, keep the original certificate in your vehicle at all times, as it is required for the exemption to be valid.

Form Preview

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

Misconceptions

Misconception 1: The exemption sticker can be transferred between vehicles.

This is not true. The medical exemption is non-transferable, meaning it is specifically tied to the vehicle for which it was issued. If you change vehicles, you will need to apply for a new exemption sticker.

Misconception 2: Any medical condition qualifies for the exemption.

This is misleading. Only certain medical conditions recognized by the World Health Organization qualify for the exemption. Conditions like albinism, lupus, and photophobia are specifically listed. A physician must provide a detailed explanation to justify the need for the exemption.

Misconception 3: The exemption lasts indefinitely as long as you have the sticker.

This is incorrect. The medical exemption is valid for a maximum of three years from the date of issuance, unless you are 60 years or older at the time of application. In that case, it remains valid for the duration of ownership of the vehicle.

Misconception 4: You can drive with any level of tint if you have the exemption.

This is a common misunderstanding. While the exemption allows for darker tints than normally permitted, there are still legal limits. For example, the front side windows must allow at least 40% light transmission. Exceeding these limits could still result in penalties.

Documents used along the form

When applying for the Louisiana Window Tint Exemption Sticker, several additional documents may be required to support your application. Each of these documents serves a specific purpose in ensuring compliance with state regulations and validating your medical exemption claim.

Medical Records: Documentation from a healthcare provider that details your medical condition. This may include diagnoses and treatment plans relevant to your need for window tinting.
Physician's Note: A letter from your doctor specifically stating the medical necessity for the window tint. This note should reference the relevant laws and your specific condition.
Proof of Identity: A valid government-issued ID, such as a driver's license or passport, to verify your identity and residency.
Vehicle Registration: A copy of your vehicle registration to confirm that you are the registered owner of the vehicle for which you are seeking the exemption.
Affidavit of Ownership: A sworn statement confirming that you own the vehicle or are an immediate family member with significant use of it.
Application for Medical Exemption: The official form that must be completed and submitted along with your request for the exemption.
Notarized Signature: A notarized signature may be required on certain forms to validate your application and affirm the truthfulness of the information provided.
Criminal History Consent: A form authorizing the Louisiana State Police to conduct a criminal background check as part of the exemption process.
Optometrist’s Evaluation: An assessment from an optometrist if your condition relates to vision issues, providing additional support for your exemption claim.
Release of Liability Form: Consider obtaining a UsaLawDocs.com to protect yourself from any potential liabilities during your exemption process.
Proof of Age: Documentation, such as a birth certificate, to verify your age if you are applying based on age-related exemptions.

Gathering these documents will help streamline the application process for your window tint exemption. Ensure that all information is accurate and up to date to avoid delays. If you have any questions about the requirements, consider reaching out to the appropriate authorities for clarification.