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Handicapped Parking Space Request Form
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This form has been modified since it was saved. Please review all fields before submitting.
The installation of a handicapped parking space does not restrict the handicapped parking space to only the person requesting the space but is accessible to anyone with a handicapped license plate or placard.
First Name of Handicapped Resident
*
Last Name of Handicapped Resident
*
Property Address 1
*
Property Address 2
City
*
State
*
Zip
*
Phone Number
*
Email Address
Does the handicapped resident own the property?
*
Yes
No
If NO, please provide the name, address, and telephone number of the property owner:
Please describe the location to be designated as a handicapped parking space:
*
Does the handicapped resident have access to off-street parking such as a driveway or garage?
*
Yes
No
If YES, please describe the off-street parking and explain why the handicapped resident does not use the off-street parking:
In order to utilize a handicapped parking space, a motorist must have a handicapped license plate or placard.
*
License Plate
Placard
List the handicapped license plate or placard number.
*
Please provide any additional information that may be of assistance to the Traffic Engineering Committee and the City Council members when they review your request:
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Email address
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