VALID FOR HALF YEAR, JAN - JUNE OR JULY

PARK & SHOP LOT PARKING PERMIT APPLICATION

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 I have 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 #

Format: (000) 000-0000.

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

Half Year (Jan - June or July - Dec) permits may be renewed using this application. Please bring your actual permit placard into the borough office when renewing. Fee per half year, Jan - - June or July - Dec 2026: $190.00 each *No Proration* *Noteworthy: Limited number of Park & Shop spaces are available. Please check if space is

Applicant Signature

VALID FOR HALF YEAR, JAN - JUNE OR JULY - DEC 2026