|
PLEASE PRINT
LAST NAME:
______________________________ FIRST NAME ____________________ TEL.:
_______________
ADDRESS: _____________________________________________________________________________________
MAILING ADDRESS (if different
than above): _________________________________________________________
VEHICLE DESCRIPTION: YEAR _________ MAKE
__________________________ MODEL _______________
VEHICLE LIC PLATE # (required) _________________________________________________ STATE ________
PERMIT FEE: $25.00 SECOND/LOST PERMIT $5.00 RESIDENT 65 OR OLDER NO
CHARGE
Mail To: Town of Gardiner PO BOX !, GARDINER, NY 12525
Make
Checks Payable to: Town of Gardiner
* ENCLOSE A STAMPED SELF ADDRESSED ENVELOPE IF TO
BE RETURNED BY MAIL
AMOUNT ENCLOSED $
Received by: _______
Date:
___________Â
Permit #: ________
|
