City of Aliquippa – Beaver County, Pennsylvania



CITY OF ALIQUIPPA581 FRANKLIN AVENUEALIQUIPPA, PA 15001724-375-5188, EXT 1APPLICATION FOR HANDICAPPED PARKING (RESIDENTIAL ONLY) FEE $25.00 PER YEARAPPLICANT’S NAME ____________________________________________________ADDRESS_____________________________________________________________PHONE_______________________________________________________________THIS APPLICATION IS A _________RENEWAL___________NEW APPLICATIONIF DIFFERENT LOCATION THAN ADDRESS, PLEASE EXPLAIN WHYARE ANY OF THE FOLLOWING AVAILABLE AT THE REQUESTED LOCATION?____________________OFF STREET PARKING___________________DRIVEWAY___________________GARAGEIF YES, PROVIDE EXPLANATION WHY IT CANNOT BE UTILIZEDNATURE/SEVERITY OF DISSABILITY_________________________________________________________NAME AND ADDRESS OF VEHICLE OWNER (AS LISTED ON VEHICLE REGISTRATIONHP (HANDICAPPED) OR SDV (SEVERELY DISABLED VETERAN) LICENSE PLATE NO,___________________VEHICLE MAKE________________VEHICLE MODEL_____________________________VEHICLE YEAR _________________VIN:_____________________________________IS THIS VEHICLE MODIFIEID TO ACCOMMODATE YOUR DISSABILITY? ____________________IF YES, PLEASE EXPLAIN______________________________________________APPLICANTS SIGNATURE_____________________________________________SIGNATURE & RELATIONSHIP OF PERSON COMPLETING THIS FORM_______________________________FOR CITY USE ONLYCITY OFFICIAL________________________________DATE:___________________________DISSAPROVED FOR THE FOLLOWING REASONS:________Falsification of Information________Off Street Driveway Parking garbage appears to be available at residence________Providing HP Reserved Parking may create an inconvenience to others________Adequate HP Reserved currently exists near residence________No HP (Handicap) or SDV (severely disabled veteran license plate)________Current parking restrictions prohibit parking at this location ................
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