DEPARTMENT OF GENERAL SERVICES POLICE
DEPARTMENT OF GENERAL SERVICES POLICE
BALTIMORE STATE OFFICE CENTER
PARKING FACILITY PROX ACCESS
201 Building Garage Parking - After 4:00 PM
Advanced Notice Request Form
The purpose of this form is to allow access to the 201 Building Garage after 4:00 pm on business days. The PROX System will allow reports to be produced and reviewed to ensure proper use. Seventy-two hours advance notice is required.
Name: Date of Birth:
(Print) LAST FIRST MI
DHMH/Agency: Last four numbers of Social Security Number ___________________
Office Address: Office Phone #
Front Card Number: Back Card Number:
Authorization Signature:
(Appointing Authority/Supervisor)
Print Name: Phone:
Title:
Justification:
□ Regular Monday through Friday
or
□M date □ T date □ W date □ Th date □ F date
or
Beginning date: Until date: Entry time 4:00 pm
Please Note: This should be limited to staff working after 5:00 PM
Authorization
Central Services Signature: Date:
Print Name:
1 November 2006
................
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