_______________ Avenue

_________ _________

_________ _________

NAME

ADDRESS

CITY _________ STATE _________ ZIP _________

DAYTIME TELEPHONE NO.

Permit holder agrees to abide by rules which are found on the back of the customer receipt.

Make check payable to City of _________.

Payment for rental must be received by the City Collector no later than the 1st business day of each quarter, being: Jan. 2, April 1, July 1, Oct. 1: Rentals not renewed by the 15th of the new quarter will result in automatic cancellation without further notice from the City.

Address all inquiries to Parking System Supervisor, _________, _________ Avenue, _________, _________ _________.

Please place sticker on REAR WINDOW or REAR BUMPER in the lower LEFT on driver's side.

1. The City of _________, its employees, and agents assume no responsibility for any damage to person or property arising out of this rental.

2. The permit issued upon the City's acceptance of this application must be displayed at all times or citation in accordance with Sections _________ _________ and _________ of the City Code will result. Failure to display subsequent current permits may also be cause for citations or revocation of this permit.

3. The City reserves the right without remuneration to post temporary restrictions to parking for purposes of facility cleaning and maintenance.

4. The permit constitutes a license to park in the subject facility. Guarantee of a space is not implied. The number of permits sold exceeds the number of spaces in some lots.

5. The permit issued is for the above-described motor vehicle only. This rental cannot be sublet, assigned or transferred.

6. Payment for rental must be received by the City Collector no later than the 1st business day of each quarter, being: January 2, April 1, July 1, October 1. Rentals not renewed by the 15th of the new quarter will result in automatic cancellation without further notice from the City.

7. Failure to abide by the above conditions is cause for revocation of this agreement.