APPLICATION FOR HANDICAPPED PARKING/SEATING



APPLICATION FOR HANDICAPPED PARKING/SEATING

GRADUATE:___________________________ _____________________________

Last Name First Name

1. Do you need a handicapped parking permit? yes no (Circle one)

2. Do you need handicapped seating tickets? yes no (Circle one)

[You will receive 2 tickets - (1 for the caregivers & 1 for the handicapped individual)]

Name of Handicapped Individual________________________________________

Vehicle license plate: State ___________ Number__________________________

Address where parking permit / handicapped seating tickets are to be mailed:

Name____________________________________________________________

Address __________________________________________________________

City_____________________________________State_________ Zip_________

Return by 5/31/2019 to Mrs. Candice Jacobs

Lenape High School

235 Hartford Road

Medford, NJ 08055

For office use only

Permit #________________________ Date Issued___________________________

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