Handicap Permit - Lost or Stolen Form
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Information about the parking permit holder:
Name:
Address:
9-digit number from NYS Driver LicenselID Card (if any):
Stolen Parking Permit Information:
Date Permit Stolen:
Type of Permit Stolen (check one): _Blue _Red
Parking Permit No.
Date Issl1ed:
Date Expires:
Police Information:
Police Agency
AgencylPrecinct Address
Signature of Officer
Rank & Shield or Tax ID No.
Issuing Agent Use Only:
New Parking Permit No.:
Date Issued
Date Expires: