Tenant Information

Name: ____________________________ Daytime Phone #: (           )           -

Address: _________________________________________ Permit #:_______________

Vehicle Make/Model: _______________________________ License #: ______________

Land Owner Information Special Parking Conditions

Name:___________________________ Lot: _______________ Street: ______________

Address: ________________________________________________________________

Date Issued: ______ /______ /_________

When you vacate the premises referenced above and/or a parking permit is no longer needed for the above referenced vehicle, have the landowner sign the statement below and bring this sheet to City Hall for a refund ($5.00 for each complete month through May 31st.

Tenant Name:______________________ is no longer renting my apartment at

Rental Address: ___________________________________________________________

Date Apartment Vacated: ____ /____ /______ Land Owner Signature: _________________