Last Name First Name Student ID #
Driver # State Expiration Date: E-Mail Address
Permanent Address: Campus Address:
Permanent 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:
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
(Rev. 8/13)
Lock Haven University Vehicle Registration fill out all information and check appropriate box.
PA Program Campus Village
Off-Campus (living inside perimeter) Commuter
Resident (30 credits or more) Resident (29 credits or less)
Graduate Student
Resident Assistant
Official Use Only
Issued by Date
Permit#
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