2. Date:*
   Date:
4. Resident's First and Last Name*
6. Address*
8. City
9. State
10. Zip Code
12. Phone Number
16. VEHICLE INFORMATION
18. #1 Make & Model *
20. Color*
22. State*
23. Tag#*
27. #2 Make & Model
29. Color
31. State
32. Tag#
36. #3 Make & Model
38. Color
40. State
41. Tag#
45. #4 Make & Model
47. Color
49. State
50. Tag#
54. In general, only members of Congress, diplomats, and students enrolled in an accredited school, college, or university of this state or of a bordering state are exempt from Maryland registration. If any vehicle for which you are requesting a parking permit is not registered in the State of Maryland, explain:
56. A COPY OF YOUR VEHICLE(S) REGISTRATION MUST BE INCLUDED WITH THIS APPLICATION
60. FOR OFFICE USE ONLY
62. Sticker# for Vehicle #1
63. Expiration Date
    Expiration Date
64. Sticker# for Vehicle #3
65. Expiration Date
    Expiration Date
67. Sticker# for Vehicle #2
68. Expiration Date
    Expiration Date
69. Sticker# for Vehicle #4
70. Expiration Date
    Expiration Date
Leave This Blank:


72. 1. Receive an email copy of this form.
73. Email address

    This field is not part of the form submission.

74. Submit Submit and Print

* indicates a required field