9565 SW Millen Dr SG-05,6 +55-OS7
6p-057 +-G P-o 66
to
� 1
Tigard High School Area Parking Permit Application
Permit Period: September 2016—june 2018
1. Applicant name: TTOGL
Address:
Tigard, OR 97224 Phone # ��)�✓ J
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?
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 c cellation of the parkin permit(s). After cancellation, any vehicle(s) found parked in the
per,
it area b i g said ing permit(s) shall be cited.
ce//5
ig Dat
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
i
i
City of Tigard Service Address: 9565 SW MILLEN DR
ae UT11ATI'131L.LING Customer Number: 051001-001
® 1.3125 SW Hall Blvd.. I Tigard, OR 97223 i 1-888-826-7211 Service Type: RESIDENTIAL
TIGARD'S STR.VrEGIC VISION: ''The most ivulkab(e commimim in the Pncilu:Aorrhii cv Meter Size: 5/8°
11llere peol)Ic o1 111 1110 abil„ies enjoi hea/r111=C01Cd i1nerC011,1eered lil S." Service Dates: 06/28/2016 to 07/25/2016
DUE DATE: August 24, 2016
Bill'fig Summary For an explanation of each charge,please see the reverse side of this bill.
WATER CHARGES:
Water Consumption 7 CCF (Current Meter Read 3,773 Previous Meter Read 3,766 ) $25.74
Customer Base Charge $25.72
TOTAL TIGARD WATER CHARGES: $51.46
.................................................................................................................................................................................................
SEWER AND SURFACE WATER CHARGES:
Sewer Usage Charge Based on your Winter Average of 8 CCF $14.01
Sewer Base Charge $26.41
Surface Water Management Charge $9.75
TOTAL SEWER AND SURFACE WATER CHARGES: $50.17
...................................................................................................................................................................0............................
OTHER CHARGES:
Residential Street Maintenance $5.30
Residential Parks&Recreation Fee $3.75
TOTAL OTHER CHARGES: $9.05
................................................................................................................................................................................................
Compare Your Water Usage TOTAL CURRENT BILLING: $110.68
CCFS Water consumption is charged per 100 cubic feet(or CCF).Each CCF=748 gallons. PRIOR BILLING:
10 Previous balance(as of July 2S, 2016): $0.00
8 Adjustments: $0.00
6 Payments received-thank you: $0.00
TOTAL PRIOR BILLING: $0.00
4 TOTAL DUE: $110.68
z
0
.UG-11 1E115 01111 WWII UE111 1AN'11, 1.11 M11R'11 AGR11 MAl-11 1UN'11 1U111
■ Current Year Previous Year Last year's water usage in same billing period: 0 CCF
r---------------------------------------------------------------------
DISCOVER THE BENEFITS-SKIP THE CLUTTER AND SAVE THE PAPER.WITH OUR CONVENIENT PAPERLESS BILLING YOU RECEIVE YOUR BILL ONLINE AND GET AN
1 EMAIL NOTICE WHEN IT'S READY.VIEW YOUR BILL ANYTIME,VIEW PAST BILLS,AVOID LOST OR MISPLACED BILLS AND HAVE THE CONVENIENCE OF SEEING ALL
1 THE INFORMATION ASSOCIATED WITH YOUR UTILITY ACCOUNT.IT'S A SUSTAINABLE,EARTH-FRIENDLY CHOICE.SIGN UP AT
1
1 HTTPS://TIGAR D.M ERCHA NTTRANSAC r.COM
------------------------------------------------------------------------
Please return this portion with payment. Please DO NOT staple or tape check to the coupon.
❑ FOR CHANGE OF ADDRESS,PLEASE CHECK BOX AND COMPLETE FORM ON REVERSE SIDE-
S City of'Ti(rard I UTHAT4'BILIANG
13125 SW Hall Blvd.
I Tigard,OR 97223 DUE DATE- August 24, 2016
TTL UE: $110.68
ADDRESS SERVICE REQUESTED Service Address: 9565 SW MILLEN DR
Customer Number: 051001-001
2536 1 AV 0.376 6/328 02564 0001:0001 Make check payable to:City of Tigard.
�I�I�r���tlll'�I��II�IIIIIII�"11111 t1���tlll��rt�tl�l11111���1) 503-718-2460 www.tigard-or.gov
JEFF& HOLLY BENGTSON
9565 SW MILLEN DRQ` IIIItl11111�11'tl���1r11111��nllu��ln�1�1111111�1i1'llllltll'�
TIGARD OR 97224-6510
CITY OF TIGARD
P.O. BOX 3129
PORTLAND,OR 97208-3129
10105100100100000000011068?
OREGON
PASSENGER REGISTRATION
PLATE NUMBER TITLE NUMBER PROCESS DATE EXPIRATION DATE FUEL TYPE EQUIPMENT NO.
205HTL 1532018762 111615 OCT 18 19 GASOLINE
YEAR MAKE STYLE MODEL VEHICLE IDENTIFICATION NUMBER WEIGHTlLENGTH
2015 TOYT UT HGH 5TDJKRFH2FS209195
TITLE BRANDS - NONE - ODOMETER READhNG ODOMETEP.DATE
33 10/18/15
OWNER/
ODOhviETE-RM ESSAGE
LESSEE
RAHN BENGTSON, . HOLLY DEE
BENGTSON, JEFFREY ROBERT
COUNTY OF COUNTY OF
RESIDENCE USE
�`` WASHINGTON
ADDRESS
V !
4
PASSENGER REGISTRATION CARD
PLATE NUMBER TITLE NUMBER FUEL TYPE FARR9 ID NO. NEW EXPIRATION DATE
1937DEJ 0718057437 GASOLINE MAY 23 , 2017
EAR MAKE STYLE ;15
ODEL VEHICLE IDENTIFICATION NUMBER HVUT DATE
2007 FORD PU 1FTPW14V47FA71119 FEE
EQUIPMENT NO, WEIGHT/LENGTH TITLE BRANDS
NONE - $86 . 00
ODOMETER READING ODOMETER DATE ODOMETER MESSAGE
a
c
}O�Olop VgyC
sip uc
� � C
• r� F
�,.
U
����•OP TRA�K'���
,BENGTSON, JEFFREY ROBERT �.
COUNTY OF RESIDENCE COUNTY OF USE
T!GARD_-OR---9-7-2-2-4-5B11- WASHINGTON
N ADDRESS(HOUSE NUMBER,STREET,CITY,STATE,ZIP CODE) VALI 5
945
NEW PLATE NUMBER NEWjSTIQISERl74j'IB��
7722667766
V
1