INC. VILLAGE OF CEDARHURST 2012 Non Resident 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________________________________________________________