South Greensburg, Pennsylvania



APPLICATION FOR HANDICAP SIGNThe designated space is NOT exclusive to the applicant or premisesAny Person(s) in possession of a Valid disability placard or vehicle registration plate may park in the designated space.REQUIREMENTSApplicant must be a Borough ResidentApplicant must possess a valid Disability Placard or Vehicle registration plateA Onetime fee of $125.00 must accompany this application upon submissionA copy of the Placard or Vehicle Registration must be providedA copy of the Applicant’s Photo Identification must be providedThis application process must be completed on an annual basis between March 1st and March 31st and is the Sole responsibility of the APPLICANT. Failure to comply with this process may result in the elimination of the designated space/sign and therefore subject to an additional fee of $125.00 to have the sign re installed. This process is necessary to ensure accurate records. Additional copies of this form are available at the South Greensburg Municipal Building, 1515 Poplar Street, Greensburg Pa. 15601 (724) 837-8858.Submit Application to:South Greensburg Borough1515 Poplar StreetGreensburg, Pa. 15601 FORMCHECKBOX Disability FORMCHECKBOX Severely Disabled FORMCHECKBOX Temporary Placard FORMCHECKBOX Permanent DisabilityPlacard #Last Name FirstPhoto ID # OR SS#DOBStreet AddressCityStateAgeName or Parent or person in Loco Parentis caring for a child under the age or (18)Applicant Phone #Signature of Applicant or Person in Loco Parentis ................
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