25cc2599_Affairs_Forms_and_Publications__Description
[Form] Lost Placard Form [Instructions] Print the name and address of the placard holder (person placard has been issued to). Please provide placard number (if known). Please supply at least one of the following for the placard holder: 1) Massachusetts License/ID Number; 2) Social Security Number; or 3) Date of Birth. All affidavits must be signed and dated by the placard holder or legal guardian. [Description] 
This form is used when your placard has been lost or stolen. Any replacement, extension or renewal of a placard, for any reason, invalidates any previous placard that may have been issued.
Massachusetts RMV - Medical Affairs Forms and Publications
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