Parking Permit Application

• Application instructions pursuant to Chapter 203 of the Village code
• Please fill in all required information below and sign to acknowledge the rules and restrictions
• Submit a Valid vehicle registration and proof of residency required
• Commuters must submit a LIRR ticket and may only park in designated commuter lots
• Employee parking permits must be submitted with a letter from the employer on letterhead
• Pemits are NOT TRANSFERABLE. Permits do not guarantee a parking space in any lot.
• Permits MUST be affixed to the rear drivers side bumper. Anywhere else is invalid
• No refunds will be issued. Head in parking only in all parking fields
• Park at your own risk. The Village is not responsible for any damages incured while parked

I have read and acknowledged the rules and regulations above:

Signature: X

Name:

Address:

Phone #:

Email address:

YEAR/MAKE/MODEL: COLOR:

PLATE: STATE:

REPLACEMENT STICKERS $15

Daytime is valid 5AM-8PM

Nightime is Valid 8PM-8AM

Amount Enclosed:

BELOW IS FOR OFFICE USE ONLY

Sticker # Expires: Date issued: Issued by:

Payment type Check Cash Credit Card