15975 SW 87th Ave Tigard High School Area Parking Permit Application
Permit Period: September 2016-June 2018
1. Applicant name: -�� J�� S y'f j, ` +"
Address: 1 5T Y C--� JW q 7-t'-, AVE T 7Z;�
Tigard, OR 97224 Phone # -503 73c, -,:;12501
2. For proof of residency, attach a copy of a utility bill, real estate title or rental contract
including name & address.
3. Attach a copy of the vehicle registration for each parking permit requested.
Each household will receive 1 guest-parking permit. If you would like more than 1 guest-
parking permit, how many would you like? 2-
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I agree to use any parking permit(s) assigned to my vehicle(s) only on the specific vehicle it is
assigned by the City of Tigard Police Department, for the purpose, it was issued. Any
parking permit(s) remain the property of the City of Tigard and may be revoked if improper
use is demonstrated. I agree to assign guest parking permit(s) to people only while visiting my
home and surrender any rights if I move. Violation of any of these understandings may result
in cancellation of the parking permit(s). After cancellation, any vehicle(s) found parked in the
permit area beariny, aid parking permit(s) shall be cited.
Signature Date
Mail this application with proof of residency and vehicle registration(s) to:
Tigard Police Department
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THS Area Parking Permits
13125 SW Hall Blvd.
Tigard, OR 97223
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OREGON
TRAIL BLAZER PASS REGISTRATION 373
TBQ�4179 152083520-41 100716 JUN OC1, 2701177 ASOLINE
cL WEIGHT/LENGTH
YEAR MAKE STYLE MODEL VEHICLE IDENTIFICATION NUMBER
TITLE BRANDS — NONE ODOMETER READING ODOMETER DATE
41060 1 05/28/15
OWNER/ ODOMETER MESSAGE
LESSEE
SMITH, DEREK ROBERT 313OWFF
15975 BW 87TH AVE COUNTY OF COUNTY OF
TIQARD OR 97224 RESIDENCE USE
NEW WASHINGTON
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Page 1
D 11 F1 0 S A L C (0) PW F1 A 'ir
P.O. Box 820 Customer Service
Sherwood, OR 97140 M - F, 8arn - .4:30pm
(503) 625-6177
ACC1.NO. ACCOUNT NAME T IPAV.DATE filIV. No. DUF DATE
01022578 DEREK SMITH 04/10/2017 0001683546 04/30/2017
Service Date Description Frequency Qty Amount
INVOICE#0001662887 3131
FINANCE CHARGE ON INVOICE#0001662887 0.50
SITE 001-DEREK SMITH-15975 SW 87TH AVE
03/28/17 EXTRA GARBAGE BAG-LARGE 14.00 60.76
05/01/17-05/31/17 90 GALLON COMMINGLE RECYCLING SERVICE Weekly 1.00 INCL
05/01/17-05/31/17 60 GALLON RESIDENTIAL YARD DEBRIS SERVICE Every 2 weeks 1.00 INCL
05/01/17-05/31/17 RED BIN RECYCLING-GLASS Monthly 1.00 INCL
05/01/17-05/31/17 32 GALLON RESIDENTIAL GARBAGE SERVICE Weekly 1.00 24.87
Subtotal: 85.63
Total Invoice Amount: 86.13
Total Account Balance: 117.44
We would like to call attention to your past due account and let you know we have not received your payment. The past
due amount was due prior to the due date on this invoice and must be paid before then. Please call our office if you have
sent payment or pay the amount shown below. Thank you.
Online Bill Pay
Thank you for signing up for Online Bill Pay. You may access your account by going to www.pridedisposal.com
and click on the Online-Bill Pay Button to log in and make a payment.
PREVIOUS BALANCE PAYMENTS NEW CHARGES ACCOUNT BALANCI�,
$31.31 $0.00 $86.13 $117.44
PLEASE RETURN BOTTOM VOI3'u1011 WITH PAYMENT
ACCT.#:
01022578
0001683546 AMT. DUE:
P*R*I*D*E Darr:: blikTF: 04/30/2017 $117.44
P.U. Box 820 AMT. PAID:
Shorwood, OR 97140
ADDRESS SERVICE REQUESITI)
5136 1 AV 0.373 16/122 05363 0001:0001
DEREK SMITH PRIDE DISPOSAL COMPANY
DILLON NUNN PO BOX 820
15975 SW 87TH AVE SHERWOOD OR 97140-0820
TIGARD OR 97224-5684
0001022578000168354600000.117446