HomeMy WebLinkAbout2nd Draft Parking Permit ApplicationCITY OF CAPE CANAVERAL RESIDENT BEACH END PARKING PERMIT
EFFECTIVE PERIOD – TO DECEMBER 31, 2012
Instructions for Parking Permit Applications
Provide all information requested on the form. Have your signature notarized and return to City Hall via mail or in person, 105 Polk Avenue, P. O. Box 326, Cape Canaveral, FL 32920-0326,
Attention: Finance Office.
REQUIREMENTS: In addition to the completed application,
(1) Copy of Florida Driver’s License OR Florida ID
(2) Copy of current vehicle registration
CITY OF CAPE CANAVERAL BEACH END PARKING PERMIT APPLICATION
I HEREBY CERTIFY THAT I RESIDE AT THE ADDRESS SET FORTH BELOW, AND THAT
I AM I AM NOT A RESIDENT OF THE CITY OF CAPE CANAVERAL, AND THAT I AM THE OWNER OF THE MOTOR VEHICLE HEREIN AFTER DESCRIBED; AND THAT I MAKE APPLICATION FOR A BEACH
PARKING PERMIT TO PARK SUCH MOTOR VEHICLE IN ACCORDANCE WITH CITY ORDINANCE NO. ____________.
I HEREBY AGREE THAT THE CITY OF CAPE CANAVERAL SHALL NOT BE LIABLE FOR ANY LOSS OF, OR DAMAGE TO THE BELOW DESCRIBED MOTOR VEHICLE OR ITS EQUIPMENT, OCCURRING WHILE SUCH MOTOR VEHICLE
IS PARKED AT ANY BEACH END PARKING METER.
PLEASE TYPE OR PRINT CLEARLY
NAME:_____________________________________________
STREET ADDRESS:__________________________________
CITY AND STATE:___________________________________
POST OFFICE AND ZIP:______________________________
FOR OFFICE USE ONLY:
VEHICLE MAKE, MODEL & YEAR:____________________ Check______ Cash______
Date Issued____________
FLORIDA LICENSE PLATE NO:_______________________ Issued By_____________
PERMIT NO.__________
FEE: _______________________
For City of Cape Canaveral Residents Only:
Check here if you would like to request that your City of Cape Canaveral ad valorem taxes be used to offset the cost of this parking permit fee.
If the address listed on your Driver License is not a Cape Canaveral address, please submit two other documents indicating residency. Acceptable documents include a deed, mortgage,
monthly mortgage statement, mortgage payment booklet or residential rental/lease agreement, Florida Voter Registration Card, Florida Vehicle Registration or Title, a utility hook up
or work order dated within 60 days of the application, Automobile Payment Booklet, Selective Service Card, Medical or health card with address listed, Current homeowner’s insurance
policy or bill, Current automobile insurance policy or bill, Educational institution transcript forms for the
current school year, Unexpired professional license issued by a government agency in the U.S., W-2 form or 1099 form, Form DS2019, Certificate of Eligibility for Exchange Visitor (J-1)
status, Utility bills, not more than two months old, Mail from financial institutions; including checking, savings, or investment account statements, not more than two months old, Mail
from Federal, State, County or City government agencies (including city and county agencies)
Two proofs of residential address from applicant's parent, step-parent, legal guardian or other person with whom the applicant resides, along with a statement from a parent, step-parent,
legal guardian or other person with whom the applicant resides, combined with two proofs of their residential address.
__________________________________________
SIGNATURE OF APPLICANT
For Notary use only: State of Florida, County of Brevard
Sworn and subscribed before me this ____ day of _______________, 20____, by __________________________
Printed name of Applicant
who produced identification: _______________________ or
is personally known to me.
Seal: ________________________________________________ Signature - Notary Public At Large