BOAT RAMP PARKING ANNUAL PERMIT APPLICATION

1 boat ramp PARKING ANNUAL PERMIT APPLICATION . Please check one: New Renewal $ ANNUAL (includes 7% State Sales Tax). PERMIT includes boat ramp PARKING with a boat trailer at the following county boat ramps: Anderson Park Fort De Soto Park Boulevard Sutherland Bayou Walsingham Park Belleair Causeway Lake Seminole Phillipe Park Taylor Park War Veteran's Memorial PERMIT also includes beach PARKING without a trailer at the following beach parks: Fort De Soto Park, 3500 Pinellas Bayway, Tierra Verde, FL 33715. Fred Howard Park, 1700 Sunset Drive, Tarpon Springs, FL 34689. Sand Key Park, 1060 Gulf Blvd, Clearwater, FL 33767.

2 DISCOUNT PASS AVAILABLE: Senior PERMIT : $ ANNUAL (includes 7% State Sales Tax). Please note: You must be 65 years of age or older and provide a photocopy of your valid State Driver's License or State issued identification. Disabled US Military - ANNUAL / NO CHARGE Limit of one per military applicant without possession of a state issued Disabled PARKING PERMIT /tag. Must present an official letter from the DVA verifying a service related disability percentage AND a DD214 card or V designation on a state driver's license. Name Last First Business Business Name Business Phone if applicable Mailing Street Address Address City State Zip Code Phone Home Cell Number(s).

3 Email Address Limit of 3 vehicles per household. If more than one vehicle is requested, include a copy of the state issued registration for the additional vehicles. All vehicles must be registered at the same address. Vehicle 1 Vehicle 2 Vehicle 3. (State Vehicle Registration required) (State Vehicle Registration required). License Plate Vehicle Registration address if different from mailing address Registration Street Address Address City State Zip Code PAYMENT METHODS: Money Order, Cash, Check, Credit Card (MasterCard/Visa only). Please do not send CASH through the mail. *Make check payable to: Pinellas County BOCC.

4 If check is returned by your bank for non-payment you will be assessed a returned check fee of $30, in addition to the ANNUAL PERMIT fee. CREDIT CARD PAYMENT: Please provide Daytime Phone No. if different than above We will call you for credit card information. Daytime phone number: (_____) _____. Return by mail or in person to: Pinellas County Parks and Conservation Resources Department, boat PARKING PERMIT , 12520 Ulmerton Road, Largo, FL 33774. Main office hours are Monday-Friday 8am-5pm- Closed on weekends and holidays. Call 727-582-2100 (select 2 from the menu) for additional information.

5 ANNUAL PERMIT will be mailed upon receipt of payment or credit card validation. PERMIT will be valid through the last day of the month one year from the date of issue. The expiration date will be listed on the PERMIT . PARKING is on a space available basis. PERMIT does not guarantee a vehicle PARKING space. PERMIT is not transferable. If you have a valid Disabled PARKING PERMIT /Tag, you are not required to pay the daily or ANNUAL fee. PERMIT must be properly displayed. You do not need to be parked in a marked handicapped space as long as PERMIT is displayed. Signature: _____ Date: _____.

6 Information on this form is subject to public access