Accessible Parking Space Renewal Form

Ordinance 15-407

"*" indicates required fields

Name of Registered Permit Holder*

First Last

Phone Number*

Email*

Address*

Street Address City State ZIP Code

Location of ADA parking space if not directly in front of your home

Are you still in need of this permitted space?*

Yes

Handicap License Plate Number or Handicap Placard Number*

Expiration Date*

E-Signature of person to whom the space was issued*

Please type your full name to serve as your electronic signature on this application.

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