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Free Louisiana Window Tint Exemption Sticker Form

The Louisiana Window Tint Exemption Sticker form is a document that allows individuals with specific medical conditions to apply for an exemption from the state's standard window tint regulations. This exemption is crucial for those who require additional sun protection due to health issues, enabling them to legally use darker window tints on their vehicles. To initiate the process, individuals must fill out the form accurately and submit it for approval.

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The Louisiana Window Tint Exemption Sticker form serves as an essential resource for individuals seeking to legally equip their vehicles with window tint that exceeds standard regulations due to specific medical conditions. This form is designed for the registered owner of a vehicle or their immediate family member, allowing them to apply for a medical exemption that permits darker window tinting than typically allowed under state law. It includes critical sections for personal identification, vehicle details, and a declaration of medical necessity, along with the requirement to provide a physician’s endorsement. The form stipulates that the exemption is valid for a period of three years, although individuals aged 60 and older may receive a more extended duration, contingent upon their ownership of the vehicle. Additionally, it mandates the affiant to confirm their criminal history and grants the Louisiana State Police access to pertinent medical records. The process emphasizes the importance of accurate information, as any falsification can render the exemption invalid. Furthermore, the form outlines specific medical conditions recognized by the World Health Organization that may qualify for this exemption, ensuring that those with legitimate needs can obtain the necessary accommodations while adhering to legal standards.

Sample - Louisiana Window Tint Exemption Sticker Form

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

↓ Louisiana Window Tint Exemption Sticker File

Form Characteristics

Fact Name	Description
Purpose of the Form	The Louisiana Window Tint Medical Exemption Affidavit allows individuals with specific medical conditions to legally use darker window tint on their vehicles.
Governing Law	This form is governed by Louisiana Revised Statutes (L.R.S.) 32:361.1 and L.R.S. 32:361.2, which outline the regulations regarding window tinting and exemptions.
Validity Period	The medical exemption is valid for three years from the date of issuance, unless the vehicle owner is 60 years or older, in which case it lasts for the duration of ownership.
Required Information	Applicants must provide personal information, vehicle details, and a declaration of their medical condition to qualify for the exemption.
Non-Transferable	The medical exemption is non-transferable, meaning it cannot be used by anyone other than the individual for whom it was issued.
Alteration Consequences	Any alteration or falsification of the original certificate renders it void, and the original must be carried in the vehicle at all times.
Medical Conditions	Conditions such as albinism, lupus, and photophobia may qualify for the exemption, requiring detailed descriptions from a physician.
Approval Process	The Louisiana State Police may consult the Medical Advisory Board to determine whether to grant the medical exemption based on the submitted information.

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