Last Name: First Name: University ID #:
Driver # : State: Expiration Date: E-Mail Address:
Home Street Address: Office Building:
City, State Zip Code: Office Room #:
Home Phone #: Office Phone #:
2door 4door SUV Truck Van N/A
#1 Vehicle Year: Make: Model : Body Style:
Color/s: Plate#: State: Exp. Date:
Owner/s: Address:
2door 4door SUV Truck Van N/A
#2 Vehicle Year: Make: Model: Body Style:
Color/s: Plate#: State: Exp. Date:
Owner/s: Address:
2door 4door SUV Truck Van N/A
#3 Vehicle Year: Make: Model: Body Style:
Color/s: Plate#: State: Exp. Date:
Owner/s: Address:
2door 4door SUV Truck Van N/A
#4 Vehicle Year: Make: Model: Body Style:
Color/s: Plate#: State: Exp. Date:
Owner/s: Address:
I agree to abide by the Lock Haven University Parking Rules and Regulations and accept all responsibility for any parking
ticket violations that are issued to the above registered vehicle/vehicles and further agree to satisfy all payment of fines of said
violations.
Signature Date
Lock Haven University Vehicle Registration
fill out all information and check appropriate box.
Administration Manager Health Service Employee
Faculty Coach
Staff Temporary Staff anticipated end date
Resident Director Food Service Employee
Issued by Date
Permit#
