8/8/2019 Student Decal Application Form

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Date received:______________________

PARKING PERMIT APPLICATIONPlease provide a copy of current vehicle registration at time of application

Type of permit requested check only one:

Resident Commuter Motorcycle Gym Member Other ___________

Clearly print current information requested below:

Name: _______________________________________D.O.B: ________________________

Email address: ________________________________________________________________

Campus/local information:

Address: _________________________________________ Cell: ______________________

City: ______________________________State: __________ Zip: _____________________

Home information:

Address: ________________________________________Phone: ______________________

City: _______________________________State: _________Zip: ______________________

Vehicle Information: Are you the registered owner of this vehicle? Yes No

Plate # Plate type State Make/Model Color Year

__________________________________________________________________________________________Plate # Plate type State Make/Model Color Year

Plate types:

PC = Passenger CR = Conservation TS = Troop Support BC = Breast Cancer Awareness AG = Agriculture VT = VeteranSW = Sportsman LB = Lobster UM= UMaine System CO = Commercial CM = Combination BB = Black Bear DX = Disability

IMPORTANT: BE SURE TO READ THE INFORMATION ON THE REVERSE SIDE. SIGN THE FORMWHERE INDICATED AND INCLUDE PAYMENT IF NECESSARY.

AMOUNT PAID: _____________ TYPE OF PAYMENT: SB / CASH / CHECK / BC / IDO

PERMIT #/TYPE ISSUED:_______________ DATE/PERSON WHO ENTERED: _______________

8/8/2019 Student Decal Application Form

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Please complete this application, read and sign below.

Purchase in person at: Parking & Transportation Services OfficeLevel One of Parking Garage

88 Bedford StreetPortland, Maine 04104

Submit by mail to: University of Southern MaineParking & Transportation Services Office96 Falmouth StreetP.O. Box 9300Portland, Maine 04104-9300

Fines for any outstanding violations must be paid prior to issuance of a new permit. Questions may be directedto the Parking & Transportation Services office, 780-4718, open from 7:30 AM 6:00 PM, Monday through

Friday. Responsibility AcknowledgementI understand that:

y Knowledge of the parking rules is my responsibility and I agree to observe all of the University ofSouthern Maine Motor Vehicle Rules, http://www.usm.maine.edu/police/aboutpt.htm

y If any of these rules are unclear to me, I should contact the Parking & Transportation Services Office forclarification prior to parking in a questionable place or manner

y The permit issued to me is for my personal use and it is my obligation to see that it is properly displacedat all times

y The permit remains the property of the University of Southern Maine and that I am paying for theopportunity to park on campus.

y Possession of the parking permit does not ensure there will be a spot availabley Any alteration to, or unauthorized use of, the permit is a violation that will be referred to the Police

Department

y Any vehicle connected to me by being listed on this form, displaying a permit assigned to me, registeredwith a state in my name, or that I drive to campus is subject to being cited and possibly impounded,towed, and stored or immobilized at my expense when found in violation.

y Lack of a convenient parking space is not a valid reason for parking in violation of the rules as stated onour website http://www.usm.maine.edu/police/aboutpt.htm

I agree to promptly pay fees for all citations received without further notice. I understand that an appeals

process is available and I must file my first appeal within ten days of receiving the citation. Appeals seekingexemption or exclusion from the established parking rules will not be considered. Violation totals in excess of$100 could result in your vehicle being towed, booted and/or a hold placed on your student account preventingregistration for classes and the receipt of a transcript.

I further acknowledge that the University of Southern Maine neither assumes nor has any responsibility fordamage to any vehicle parked on the University property or any vehicle that is damaged while being towed,immobilized or stored.

Signature: ________________________________________________Date: ___________________________