VALID FOR 2025- QUARTERLY

Q4
Q3
Q2
Q1
PARK & SHOP LOT PARKING PERMIT APPLICATION
VALID FOR 2025- QUARTERLY
MONDAY - FRIDAY (LOT OPENS AT 7AM AND CLOSES AT 9PM)
ONLY FOR USE AT: PARK & SHOP LOT
NOT VALID FOR ANY TWO-HOUR METERS OR TEN-HOUR METERS.
WINTER OVERNIGHT PARKING RULES REMAIN IN EFFECT
By signing below, I understand, and I am certifying: 1. I will not use this permit for any vehicle other than the vehicles on this original application. 2. If I dispose of a vehicle and replace it with another, I shall notify Honesdale Borough parking enforcement of all new vehicle information or I may be ticketed. If my vehicle is in the shop and Ihave a loaner/rental, I may use my original permit if notifying the borough by 10AM , failure to do so, will result in tickets being valid. 3. There are no designated/reserved parking spaces for anyone. When making application: 1. Please complete this form in its entirety (front and back) 2. Please have the following vehicle information available: a. Year, make, model, and color b. license plate number
Print Name
Print Address
Cell Phone #
Home
Work
Employer optional
Vehicle 1 Year Make Model Color
Vehicle 1 Plate number
Permit
Vehicle 2 Year Make Model Color
Vehicle 2 Plate number
Permit
Vehicle 3 Year Make Model Color
Vehicle 3 Plate number
Permit
Quarterly permits may be renewed each quarter using this application. Please bring your actual permit placard into the borough office when renewing. Fee per each quarter through December 2025: $95.00 each *No Proration* *Noteworthy: Limited number of Park & Shop spaces are available. Please check if space is
Applicant Signature

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Cash
Check Number
Date

MonthDayYear
Date
Borough Representative Signature

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Should be Empty:

PARK & SHOP LOT PARKING PERMIT APPLICATION

VALID FOR 2025- QUARTERLY

MONDAY - FRIDAY (LOT OPENS AT 7AM AND CLOSES AT 9PM)

ONLY FOR USE AT: PARK & SHOP LOT

WINTER OVERNIGHT PARKING RULES REMAIN IN EFFECT