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HomeMy WebLinkAboutAPPLICATION - HANDICAP PARKING PERMITFLORI % ' lARTMENT OF WrHWAY SAFEiYAND MI 'VEHICLES APPLI". AN FOR DISABLED PERSON PAW ",, 9 PERMIT --suBMEFAPPLICAIIONTOYDURLOcALcoumYTAXcoui mRgaOFFICEORLUSOISEPl. ' - wwmfll�aavt�w(ptfices! . This form is not valid for more than 12 months from the dafe.ofthe certW3 ing aufh C,YW�S�o hf)•r L �.( (ems Nlumat Pmsm�as anm�r (]mentO4ra6ledPeddn4Pe�m3N,aaher �•�', S�ae hnfMwWed Parson*rGump2m a0ienhled Floods OdvarticonseorRmidem Card' ..Iffam9cwd)Pmcoit- .cif;.: Maleafehth io (.-.: s Dhableditn='@n®OAd&n OlsaW.W ferns Ram Number • - u G FlmWaDdverUoensaarFladdnmNmhbec (�9d+edfaPco! ahlcmyP9t.— (�ll/_ " -i(o�' L:IZ.,�G tic7` Re))pIINdGie. CbeCiC011e M9tejfoQafMgg: 'wife afro MAire ahm iaiiragmthf Wc- ❑ mdassetmpymsmnomdb7tP>7bdwI": A�lr3 Fr"..°1 PHYSICIANlCE11 IFYING PRACTFRONER'S STATEMENT OF CERTiFICKRON (See MWORARYPEOOT. 'Thismmaed'dyfh ih'app6=tnemedabave(sapm'=.' v0habempmmydm6Qily(sbia vraysartsmmpamr8ystgMMpabed. Ouemthetea@drmyadlsabTmy(�) dmcimdhalaa(28),Wedt�a6lad ttm®It p j (data)fhmuab (dad} JMIA J( PFSAIA[OURPBOUT: 7N5(et&cwWtheoppBmMiiamedabomistaga%rbraidwlsadsabladlie=nwlhapmman hWiwahMtymwadk2Mfe4wtlydutsbmftmrest. SpmSybelow(p.8)eghartaga%,bBW rthespecffledlmbffd7t(des). 02 bmbH�.m vmgcadywidmease otorasda�icefnnnabram.mtm.nndrb. musmedcdeuFae.�ag�erdevrr:x orwlNdfdassL4aztce Warjugiarpatson. R81e aannppwr ParRm9 pmmu.. _ ",M 3 The naetllgpammueiiH waavateetdmlr •' ;, '�_ �4. Ras>ddTo6fiylmlgdwgjetCtlteabant8iattlmPea fSftXd(n4bamW)e*1ra Wvdwmfar7 second. when inansaed bysPhameby, fslaitlimt am Mum . lheperson�eAar®l mygenb�ssthert 6anmdhgonraom eb'atred. - .e ' l� 2a; Yet S. Use afpodaNe�mrygmt. ' '-. •t: RBSMctbnby- funetimmlgm2aliammadas+,iip3(nsereddyas Class RiwCfamiVa ardingto sffi�datdssat bygre Amsft tHeatAsmdaffm g7r '-'❑7 3evma nlnapaswr'sataTdymvragtduammedNillq nemotoglml. oror0rapemecan�lar. '.� �afeAaarL6lpnrflM.am Me eaNdimhmNanOafomahid can •stafyl - ".;Et. WARNING: NerPam�emnmsawarglymabsam7®orWet®dmg damma�NseapPllraHaaar�mtln®t1®imder�on �.aa4a, FteddaS,wvmtlba mtaderheanaf 6fffieftratdegiee, pumalmhm aspiavlded fosddloriTF3.a82 aTlaa,ia'P.S Sda"Iw�Uylsopfaamy�ta)ag oralNe�olf7,dag orbofh Oaacftnarl7mm rim gu pdmd) n' 'y� _ofe Physldmt:'OSZeapammac.Fo@m�PhystVait, chimprad� i�t^Y. Opwnwbist. Advm®d FbgbWmd Nmse RadX varandetOmpraW.O fd 6corsedplgsir�noraPlrysdml-Aatstmd gmtLsedunaer Om 45gar t ' UGENSFDfA RIESTATEOF etcf�� r ' 3 � Nmaa of - ane, t. x"..: .. , .. Cwffft Amho s _ - pate [� .. Area Code T' aNmnber 0 tiPLT.I{S.E7oCwnDRrhe SBd15aNadeppg®tfmrpeaeboveappSyingtaiapeaommMPfa����m oblmnaFludda advergrenmorid�uaCma�aaN- lftha Spm:WE=epgmbmisdmcftd.ot6cmerp,mplryfti-anartprovldeF ?(glmtmea�dem Fmlav SGA `IC� - Bfhe Eae bu!3chadmd.moffhiiciM iibams28almvemustatmbee(iedad. APPUCAMON SYAN CMGAN¢AT(ON (Sea WandfgAbaue) - lAblamamhTyOratpmvldes tagulerbanspadrd'mnserviatmdlSaNetl permstmrfiig d,eVabiGrymaavc'orare mdSedmhe legatb,hTmd . NM kbrre=wWs and mplaamerds ooty a vebmatwhobas been prevtausly ml ated and caddied hrythe_UaitedStates Depamnentaf Vcdarans•AHans army nu• 6rmt� oFtbe United SYaf¢s Armed Forces aa.pe�aoanadht and tatalty dlsaMed tram a smuts- disabiRtY may gravide a um"ted 57ahe57Oepartnrertt of VehvansARairsForm iefirg2733iari6eyWvalalt•(ssaedvvifh[Itthelastl2maaMsin Rea dfaoatiR feafd-salrgdy- ' HSMV 83M - REV.10115 SCANNED BY St. LUciprnitni Mal To: CHMMPHER L Tf= 710 OLIVE ST FORT PIERCE, FL 349BZ 4042 CO/AGY 24 12 To FLORMA PARKING PLACARD REGISTRATION PERMrr 00974975 TYPE PFUMARY Expires MIdllightSRt10114M023 Reg.Tax 0.00 wm Rey C000tyPee 0.00 Mal Fee DUFM T460112603740 Sales Tax Dale issued 7123t2019 VolnmmyFees rr dTotal 0.00 CHRISTOPHERLTYLER 1. Y=xc&hWmmndTmnp&tcdbDyomrmwaddmmwhbm 710OLIVEST 2- FORT PIERCE, FL 349824042 the 30day pedodpdDrw&eeepimtion dace shown on visa aod=mepnmidedesaeomte7andm nd=gmirdfcr= 0 0