Inc village of east rockaway • 376 atlantic avenue, P. O. Box 189 • east rockaway, new york, 11518-0189

(516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305

• 
  Please fill in required information below, check the type of permit you need and attach proof of residency and a copy of the vehicle registration. Commuters must submit train ticket as proof.
  
• 
  If you are filing for an Employee Parking Permit, please attach proof of employment (A letter from Employer on letterhead).
  
• 
  Be advised that permits are NOT transferable. If you are filing for a replacement sticker: remove and return the old sticker with new application and include a copy of the new registration.
  
• 
  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.
  
• 
  NO REFUNDS WILL BE ISSUED.
  

Applicant’s Name______________________________________________________________________________________________

Address: ____________________________________________________________ Apt:/Floor:______________________

______________________________________________________________________________________________

Home Phone #: _ ____________________ Business Phone#:_____________________ Mobile Cell Phone :____________________

Email address: (Optional) _____________________________________________________________________________________

PLATE# ________________ YEAR: ______________ MAKE: ______________________________________________

MODEL: ________________ COLOR: ______________ STATE: ______ Signature: ______________________________

ANNUAL ( ) ________ 2014 ___________ 2014--2015 $200.00

MONTHLY FEE ( ) ________ 2014 ___________ 2014--2015 $ 30.00

- EMPLOYEE DAYTIME PARKING: (Employees must submit proof of employment)

MONTHLY FEE ( ) ________ 2014 ___________ 2014--2015 $ 30.00

ANNUAL ( ) ________ 2014 ___________2014--2015 $300.00

MONTHLY FEE ( ) ________ 2014 ___________2014--2015 $ 40.00

___________________________________________________________________________________________________________________
-COMMUTER/RESIDENT DAYTIME/OVERNIGHT: (Parking Fields #1-St. Raymond’s, #2-Forest Ave, #3-Ocean Ave North and #4- Ocean Ave South)

Valid between 5AM-8PM only

ANNUAL ( ) ________ 2014 ___________2014--2015 $150.00

MONTHLY FEE ( ) ________ 2014 ___________2014--2015 $ 25.00
-COMMUTER/NON-RESIDENT DAYTIME/OVERNIGHT: (Parking Fields #1-St. Raymond’s, #2-Forest Ave, #3-Ocean Ave North and #4- Ocean Ave South)

Valid between 5AM-8PM only

ANNUAL ( ) ________ 2014 ___________2014--2015 $225.00

MONTHLY FEE ( ) ________ 2014 ___________2014--2015 $ 35.00
- REPLACEMENT STICKERS: For replacement of one vehicle to another ONLY. PROCESSING FEE( ) Per sticker / per vehicle $ 15.00
**IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER
--------------------------------------------- For Office use Only --------------------------------------------- For Office Use Only ---------------------------------------------
Sticker # ____________ Expires: ____________ Sticker # ___________ Expires: ____________ Date issued: ____________ Permit issued by: ________
Check________ Cash_________ Charge____________

Check this box to certify that you have read the above requirements and will comply therewith _____________________________

INC. VILLAGE OF EAST ROCKAWAY • 376 ATLANTIC AVENUE, P.O. BOX 189 • EAST ROCKAWAY, NY, 11518-0189

(516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305

• 
  Fill in required information, check the type of permit needed and submit a copy of the vehicle registration.
  
• 
  New residents must attach proof of residency and a copy of the vehicle registration.
  
• 
  Commuters must submit train ticket as proof of commutation status.
  
• 
  Employees must have proof of employment (A letter from Employer on letterhead).
  
• 
  Permits are NOT transferable. If you are filing for a replacement sticker, you must remove and return the old sticker with new application and include a copy of the new registration, at a cost of $15,00 per vehicle..
  
• 
  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.
  
• 
  **A PARKING PERMIT DOES NOT GUARANTEE A PARKING SPACE AT ANY OF THE MUNICIPAL PARKING LOTS**.
  
• 
  **NO REFUNDS WILL BE ISSUED**.
  
• 
  **IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER
  

(516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305

• 
  Fill in required information, check the type of permit needed and submit a copy of the vehicle registration.
  
• 
  New residents must attach proof of residency and a copy of the vehicle registration.
  
• 
  Commuters must submit train ticket as proof of commutation status.
  
• 
  Employees must have proof of employment (A letter from Employer on letterhead).
  
• 
  Permits are NOT transferable. If you are filing for a replacement sticker, you must remove and return the old sticker with new application and include a copy of the new registration, at a cost of $15,00 per vehicle..
  
• 
  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.
  
• 
  **A PARKING PERMIT DOES NOT GUARANTEE A PARKING SPACE AT ANY OF THE MUNICIPAL PARKING LOTS**.
  
• 
  **NO REFUNDS WILL BE ISSUED**.
  
• 
  **IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER
  

(516) 887-6300 • www.villageofeastrockaway.org • fax: (516) 887-6305

• 
  Fill in required information, check the type of permit needed and submit a copy of the vehicle registration.
  
• 
  New residents must attach proof of residency and a copy of the vehicle registration.
  
• 
  Commuters must submit train ticket as proof of commutation status.
  
• 
  Employees must have proof of employment (A letter from Employer on letterhead).
  
• 
  Permits are NOT transferable. If you are filing for a replacement sticker, you must remove and return the old sticker with new application and include a copy of the new registration, at a cost of $15,00 per vehicle..
  
• 
  Parking with a permit does NOT exempt you from inserting coins when parking at a meter.
  
• 
  **A PARKING PERMIT DOES NOT GUARANTEE A PARKING SPACE AT ANY OF THE MUNICIPAL PARKING LOTS**.
  
• 
  **NO REFUNDS WILL BE ISSUED**.
  
• 
  **IMPORTANT** PARKING STICKER MUST BE AFFIXED TO THE REAR OUTSIDE (Drivers Side) WINDSHIELD and/or BUMPER