Temporary Resident Parking Permit Medical Care Application Form

    You will need to provide a copy of your Driver’s License showing address in the district.

    * Required

    Annapolis address (residential only) *:   District:

    Is there a driveway, garage or any parking area at this address? 

    Applicant
    First Name *:

    Last Name *:

    Email Address *:

    Confirm Email Address *:

    Driver's License
    State *:   Number *:

    Phone Numbers
    Home:

    Cell:

    Work:

    If you are renting, please enter your lease expiration date:

    Permit

    Months of use (six months maximum): From:  To: 

    Fee: $10.00 per month

    Contact Person
    First Name:

    Last Name:

    Phone:

    Vehicle

    License Plate State *:

    * I hereby certify under the penalties of perjury that :

    1. I am a resident of the above parking district area.
    2. The vehicle listed above does not have any unpaid City parking tickets.
    3. I acknowledge that a temporary residential parking permit does not allow parking at parking meters, redlines, loading zones, handicapped spaces, or in areas prohibited by sign or law.
    4. I acknowledge that the temporary residential parking permit expires on the date or dates selected above.
    5. I have read this Application and the Temporary Parking Permit Information. My application and supporting documents are true and correct. This application is made for the purpose of obtaining a temporary residential parking permit under the provisions of Chapter 12.32.140 of the Annapolis City Code.

    Today's Date *: