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2. Borough of West Chester

   Handicapped Parking Permit

4. First Name*
5. Last Name*
7. Address1*
9. Address2
11. City*
12. State*
13. Zip*
15. Phone Number: *
16. Email Address*
18. State Issued Placard Number*
20. Upload Handicapped Placard
22. Signature*

    Your request will not be considered complete without ALL supporting documentation.

24. Required Documents

    Please email parkingdepartment@west-chester.com in respect to required documents.

26. OFFICE USE ONLY - DO NOT ENTER INFORMATION BELOW THIS LINE

30. Registration
32. ID CARD
33. PLACARD
35. Manager's Name
37. Agenda Date
38. Deceision

    1. Approved
    2. Denied
40. Notes
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field