APPLICATION for PARKING PERMIT Pursuant to Chapter 203 of the Village Code

INC. VILLAGE OF EAST ROCKAWAY • 376 ATLANTIC AVENUE, P.O. BOX 189 • EAST ROCKAWAY, NEW YORK, 11518-0189 (516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305 APPLICATION FOR PARKING PERMIT • Pursuant to Chapter 203 of the Village Code  Please fill in required information below, check the type of permit you need and attach proof of residency and a copy of the vehicle registration. Commuters must submit train ticket as proof.  If you are filing for an Employee Parking Permit, please attach proof of employment (A letter from Employer on letterhead).  Be advised that permits are NOT transferable. If you are filing for a replacement sticker: remove and return the old sticker with new application and include a copy of the new registration.  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.  NO REFUNDS WILL BE ISSUED.

Applicant’s Name______Address: ______Apt:/Floor:______Home Phone #: ______Business Phone#:______Mobile Cell Phone :______Email address: (Optional) ______PLATE# ______YEAR: ______MAKE: ______MODEL: ______COLOR: ______STATE: ______Signature: ______

Amount enclosed: $______Make checks payable to: Inc. Village of East Rockaway PARKING FIELD NO. ______

- RESIDENT DAYTIME/OVERNIGHT PARKING: (PARKING FROM 8PM TO 3AM IS FREE IN ALL PARKING FIELDS) Daytime -Valid between 5AM-8PM only Overnight – Valid between 8PM-8AM ANNUAL ( ) ______2014 ______2014--2015 $200.00 MONTHLY FEE ( ) ______2014 ______2014--2015 $ 30.00 - EMPLOYEE DAYTIME PARKING : (Employees must submit proof of employment) Daytime - Valid between 8PM-8AM only ANNUAL ( ) ______2014 ______2014--2015 $200.00 MONTHLY FEE ( ) ______2014 ______2014--2015 $ 30.00 ______

- NON-RESIDENT DAYTIME/OVERNIGHT PARKING: Daytime - Valid between 5AM-8PM only Overnight – Valid between 8PM and 8AM ANNUAL ( ) ______2014 ______2014--2015 $300.00 MONTHLY FEE ( ) ______2014 ______2014--2015 $ 40.00 ______

-COMMUTER/RESIDENT DAYTIME/OVERNIGHT: (Parking Fields #1-St. Raymond’s, #2-Forest Ave, #3-Ocean Ave North and #4- Ocean Ave South) Valid between 5AM-8PM only ANNUAL ( ) ______2014 ______2014--2015 $150.00 MONTHLY FEE ( ) ______2014 ______2014--2015 $ 25.00

-COMMUTER/NON-RESIDENT DAYTIME/OVERNIGHT: (Parking Fields #1-St. Raymond’s, #2-Forest Ave, #3-Ocean Ave North and #4- Ocean Ave South) Valid between 5AM-8PM only ANNUAL ( ) ______2014 ______2014--2015 $225.00 MONTHLY FEE ( ) ______2014 ______2014--2015 $ 35.00 - REPLACEMENT STICKERS: For replacement of one vehicle to another ONLY. PROCESSING FEE( ) Per sticker / per vehicle $ 15.00

**IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER

------For Office use Only ------For Office Use Only ------

Sticker # ______Expires: ______Sticker # ______Expires: ______Date issued: ______Permit issued by: ______

Check______Cash______Charge______

Check this box to certify that you have read the above requirements and will comply therewith ______

INC. VILLAGE OF EAST ROCKAWAY • 376 ATLANTIC AVENUE, P.O. BOX 189 • EAST ROCKAWAY, NY, 11518-0189 (516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305

REQUIREMENTS TO OBTAIN A PARKING PERMIT • Pursuant to Chapter 203 of the Village Code

 Fill in required information, check the type of permit needed and submit a copy of the vehicle registration.  New residents must attach proof of residency and a copy of the vehicle registration.  Commuters must submit train ticket as proof of commutation status.  Employees must have proof of employment (A letter from Employer on letterhead).  Permits are NOT transferable. If you are filing for a replacement sticker, you must remove and return the old sticker with new application and include a copy of the new registration, at a cost of $15,00 per vehicle..  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.  **A PARKING PERMIT DOES NOT GUARANTEE A PARKING SPACE AT ANY OF THE MUNICIPAL PARKING LOTS**.  **NO REFUNDS WILL BE ISSUED**.  **IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER