CITY OF BOSTON
TRANSPORTATION DEPARTMENT
OFFICE OF PARKING CLERK
RESIDENT PARKING PERMIT APPLICATION AND AFFIDAVIT
DATE: ____/____/____
NAME: ________________________________________
LAST FIRST INITIAL
ADDRESS: _________________________________________________________
STREET NO. STREET NAME APT NO. ZIP CODE
-
HOME PHONE: _______________ WORK PHONE: _______________
LICENSE PLATE: ____________VEHICLE YEAR: __ __ __ __ VEHICLE MAKE: _________
I, HEREBY SWEAR, UNDER PENALTY OF PERJURY THAT I HAVE NO OUTSTANDING
TICKETS IN THE CITY OF BOSTON, THE ABOVE INFORMATION IS CORRECT
AND THAT THE APPLICANT IS THE RESIDENT OF THE CITY OF BOSTON
RESIDING AT THE ADDRESS ABOVE AND THAT THE ABOVE REFERENCED VEHICLE
IS REGISTERED AND PRINCIPALLY GARAGED AT THE ABOVE ADRRESS.
__________________________
SIGNATURE OF THE APPLICANT
DATE THIS ________ DAY OF _______________20______
OLD PERMIT NO.__________
NEW PERMIT NO.__________
FOR OFFICE USE ONLY
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