COUNTY COUNCIL

APPLICATION FORM FOR RESIDENTS PARKING PERMIT

Tick Appropriate Town - Wexford □ Enniscorthy □ □ □

(1) Name of Applicant

(2) Address of Applicant

(3) Vehicle Reg. Number

(a) Make/Model of Vehicle (b) Taxation Class & Expiry Date

(4) Contact Phone Number

I hereby make an application for a Resident’s Parking Permit in respect of the vehicle indicated at (3) above.

I confirm that I am the owner of this vehicle and I also confirm that I am resident at the address indicated at (2) above. Please indicate whether you are the owner □ or tenant □ of the property: (please tick)

Please attach the following documents:-

(A) Photocopy Vehicle Licensing Certificate/Registration Certificate □ please tick (address must be as above)

(B) Photocopy of e.g. Utility Bill, Bank Statement etc. dated within the □ please tick last three months indicating current residential address

(C) Photocopy Valid Motor Taxation Disc □ please tick

(D) Original Expired Resident Permit □ please tick

(E) Fee of €10.00 if applying for a duplicate parking permit □ please tick

Signed: (Applicant) Date:

Please ensure application form is signed and dated where indicated.

For official use only

The above applicant has fulfilled the conditions required and the issue of the relevant parking disc is hereby approved.

Signed

Date

The above applicant has not fulfilled the conditions required and the issue of the relevant parking disc is hereby disallowed for the following reason:

Signed

Date

Residents Permit Number Street(s)

Date of issue

Entry logged

Date of expiry

SEND TO APPROPRIATE DISTRICT OFFICE:-

Borough District of Wexford Offices, 61 The Bullring, Wexford, Y35EA00 – Phone 053-9196900 – [email protected]

Enniscorthy Municipal District, Market Square, Enniscorthy, Co. Wexford, Y21W2V4 – Phone 053-9233540 – [email protected]

New Ross Municipal District, The Tholsel, Quay Street, New Ross, Co. Wexford – Y34CF64 – Phone 051-421284 – [email protected]

Gorey Municipal District, Civic Offices, Civic Square, The Avenue, Gorey, Co. Wexford – Y25V1W5 – Phone 053-9483800 – [email protected]