*Applicant's Name:  

Mailing Address:

City and Zip Code:

Phone:   *Email:

I request the installation of a disabled PARKING ZONE at:

my home address:  

a different address: 

1. What is the nature of your disability?
    
   

2. Which of the following do you use to aid mobility?
   
   WHEELCHAIR    WALKER     CRUTCHES     CANE    

OTHER (specify)

3. License plate number of the vehicle you use: 
   

4. Disabled Persons Placard No.
   

5. Issue Date:      Expiration Date:
   

6. In whose name is the above vehicle registered?
   

7. I cannot park in my driveway or garage because:
   
   I don't have a garage or driveway

My driveway is not wide enough to safely exit my vehicle.

My driveway is too steep to safely exit my vehicle.

My garage is full

Other

 

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I understand that the City of Monterey may remove this on-street disabled parking space at any time if it is no longer used for its intended purpose.

APPLICANT'S SIGNATURE (Please type in name if submitting online)

DATE