Name
*
First Name
Last Name
E-mail
*
Permit Number
*
Phone Number*
*
Registered Vehicle Information
Make
*
Model
*
Color
*
License Plate Number
*
Date(s) Requested
Start Date
*
-
Month
-
Day
Year
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End Date
*
-
Month
-
Day
Year
Date Picker Icon
Reason
*
If this is a recurring exemption, list the days/dates:
Submit
For Office Use Only
Password
Sender Name
My Email
Is this request approved?
Approved
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Remarks
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Should be Empty: