Please type or print clearly. Return all to the address above
Applicant’s Signature
LICENSE PERIOD APRIL 1 thru MARCH 31
Auto Registration with bar code must be enclosed (or copy)
Rev. 1/20
Applicant’s Name:
Street Address:
Town:
Zip Code:
OFFICE OF THE TOWN CLERK
KATE MURRAY
Town Clerk
One Washington Street Hempstead, NY 11550
Tel: (516) 812-3513 email: commuterparking@tohmail.org
RESIDENT COMMUTER PARKING
Instructions
RESIDENT COMMUTER PARKING
. ...
I HEREBY CERTIFY THAT I RESIDE AT THE ADDRESS SET FORTH BELOW, THAT I AM THE OWNER OF THE MOTOR VEHICLE
HEREAFTER 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 AGREE THAT THE TOWN OF HEMPSTEAD SHALL NOT BE LIABLE FOR ANY LOSS OR DAMAGE TO THE DESCRIBED
BELOW MOTOR VEHICLE OR ITS EQUIPMENT OCCURRING WHILE SUCH MOTOR VEHICLE IS PARKED IN ANY PERMITTED
PARKING AREA OF THE TOWN. 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. Please make check or money order payable to Kate Murray, Town Clerk.
4. The fee is $10.00 per parking permit. ( Not responsible for cash sent through the mail ).
* We now offer a reduced rate of $5 for veterans, seniors (60 & over), handicapped individuals, auxiliary police and volunteer fire and
ambulance personnel. *The parking permit fee will be waived for Active Military personnel. Adequate ID required.
5. As a convenience to our residents, mailed applications will be accepted. However, we cannot assume
responsibility for any lost mail applications.
6. Please enclose a return, stamped, self addressed envelope.
Please mail back to:
Kate Murray, Town Clerk
1 Washington Street
Hempstead, NY 11550
Not responsible for cash sent through the mail
Yr/ Make of Car: Body Type: License Plate No.: Telephone No.: *E-mail address:
Wantagh Seaford Bellmore Merrick *Baldwin
* EXCLUDING
BA-6 & BA-13
*Your email address will solely be used for Town of Hempstead purposes.
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