ELMONT - Special Parking District
Applicant’s Signature
Rev. 12/17
Permit #
Office Use Only
Date Issued
Guest Permits
OFFICE OF THE TOWN CLERK
KATE MURRAY
Town Clerk
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3513 email: commuterparking@tohmail.org
ELMONT SPECIAL PARKING DISTRICT
Instructions
I HEREBY CERTIFY THAT I RESIDE AT THE ADDRESS SET FORTH BELOW, THAT I AM THE OWNER OF THE
MOTOR VEHICLE HEREIN AFTER DESCRIBED, AND THAT I MAKE AN APPLICATION FOR A PERMIT TO PARK
SUCH MOTOR VEHICLE IN THE PERMITTED PARKING AREAS DESCRIBED IN SAID ORDINANCE OR RULES AND
REGULATIONS WHEN SPACE THEREIN IS AVAILABLE. I SHALL NOT SELL, TRANSFER, LEND OR OTHERWISE
FURNISH A PERMIT GRANTED HEREUNDER TO ANY PERSON OTHER THAN TO WHOM THE PERMIT WAS ISSUED.
1. Please complete and sign this application.
2. Your vehicle registration with bar code or a copy must accompany this application. The
registration will be returned with your parking permit.
3. Limit of Four (4) Guest Permits per household.
4. As a convenience to our residents, mailed applications will be accepted. However, we cannot
assume responsibility for any lost mail application.
5. Please enclose a return, stamped, self addressed envelope.
Please mail back to:
KATE MURRAY, Town Clerk
1 Washington Street
Hempstead, NY 11550
LICENSE PERIOD APRIL 1 thru MARCH 31
Yr/ Make of Car: Body Type: License Plate No.: Telephone No.: *E-mail address:
Please type or print clearly. Return all copies to address above
Applicant’s Name:
Street Address:
Town:
Zip Code:
ELMONT 11003
Guest Permits:
Auto Registration with bar code must be enclosed (or copy)
Not responsible for cash sent through the mail
*Your email address will solely be used for Town of Hempstead purposes.
