INC. VILLAGE OF CEDARHURST 2012 Business Application for Parking Permit

Under Penalty of Perjury, the Undersigned Affirms as Follows:

NAME_______________________________________________________________

ADDRESS____________________________________________________________

TELEPHONE # ________________________________________________________

BUSINESS PHONE # ___________________________________________________

Parking Permit will be used on the following vehicle:

MAKE________________ YEAR____________ PLATE #____________________

VEHICLE ID#________________________________________________________

It Is Understood That The Permit Is Void If Attached To Any Other Vehicle

PARKING PERMIT#____________________ DATE_______________________

Signature ___________________________________________________________

Business Name, Address & Phone Number _______________________________

___________________________________________________________________

Signature of Business Owner __________________________________________