EXTENDED PARKING PERMIT for LOT R OR W
TOWN LOT:_______________________________ FILE NUMBER________________
Name: ___________________________________ _____________________________________________
(Last Name) (First Name)
Address: _________________________________________________________________________________
____________________________________ ________ ________________
(City) (State) (Zip Code)
Dates Requested: _________________________________________ (permit is per month)
Reason for Request for Extended Parking: _______________________________________________________________
_________________________________________________________________________________________________
Make/Model/Year of Vehicle and/or Description of Trailer: _________________________________________________
License Plate Number:_______________________________________________________________________________
Amount Paid: $__________________ Received by: ____________________ Date: __________________________
Cost of Extended Parking Permit is $42.20 ($40.00 plus 5.5% sales tax)/month as per Schedule of Fees
THIS PERMIT WILL BE VALID ONLY FOR: ______________________ TO ________________________
(Start Date) (End Date)
Approved by Town Clerk/\Deputy: ___________________________________________ _____________________
(Signature of Town Clerk or Deputy Clerk) (Date)
Please prominently display extended parking permit inside the windshield of your parked vehicle, on the driver's side
where the permit can be clearly observed as per §425-17 Town of La Pointe Code of Ordinances
Approved by the Town Board December 8, 2020 for 2021
