9550 SW Millen Dr & R003 +-004-
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Tigard High School Area Parking Permit Application
Permit Period: September 2016-June 2018
1. Applicant name: r Uc's (,ai t S
Address: Cl ")- 9() sci �'}� (�6 C/ll -2)dz-1(JL
Tigard, OR 97224 Phone # -�
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. L�\ �
Each household will receive 1 guest-parking,permit. If you would like more than 1 guest-
parking permit, how many would you like?(
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 a`ny rights if I move. Violation of any of these understandings may result
in cancellation of the parking,pe'rmit(s). After cancellation, any vehicle(s) found parked in the
permit area bearing said parking permit(s) shall be cited.
Signature ) - Date
j -
Mail this application with proof of residency and vehicle registration(s) to:
Tigard Police Department
THS Area Parking Permits
13125 SW Hall Blvd.
Tigard, OR 97223
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PLATE NUMBER TITLE NUMBER FUEL TYPE FARM ID NO.
996BCB 0516 ___j__ N EVV EAF I KA I I UN IJAk I t
817842 GASOLINE MAR 12, 2018
YEAR MAKE STYLEMODEL VEHICLE IDENTIFICATION NUMBER HVUT DATE
2004 HOND 14D IV 2HGES15594H563268 FEE.
EQUIPMENT NO. WEIGHT/LENGTH TITLE BRANDS
- NONE - $86 .00
ODOMETER READING ODOMETER DATE ODOMETER MESSAGE
1
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*LEWI S, RUSSELL DONNELLY `�• •°' ,N
WALCUTT, PAMELA CLAIRE
9550 SW MILLEN DR COUNTY"OF RESIDENCE COUNTY OF USE
TIGARD OR 97224-6509 WASHINGTON
NEW ADDRESS(HOUSE NUMBER,STREET,CITY,STATE,ZIP CODE) VAyfQjI $T p
03945
NEW PLATE NUMBER
PASSENGER REGISTRATION CARD NEW EXPIRATION DATE
PLATE NUMBER TITLE NUMBER FUEL TYPE FARM ID NO. OCT 26 , 2017
029ELN 1317211719 GASOLINE HVUT DATE
YEAR MAKE STYLE MODEL VEHICLE IDENTIFICATION NUMBER FEE
2006 HOND VA DY 5FNRL38736BO42920 O
EQUIPMENT NO. WEIGHT/LENGTH TITLE BRANDS NONE $86 . 00
- -
DOMETER READING ODOMETER DATE ODOMETER MESSAGE
AO p•[OR V$y�f��
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*LEWIS, PAMELA CLAIRE •,° •" r
LEWI S, RUSSELL DONNELLY COUNTY OF RESIDENCE COUNTY OF USE
9550 SW MILLEN DR WASHINGTON
TIGARD OR 97224-6509
VALID
NEW ADDRESS(HOUSE NUMBER,STREET,CITY,STATE,ZIP CODE) �c
NEW PLATE NUMBER