Name: ____________________________

Address:_____________________________

Driver's License #: ____________________________

License Plate #: ____________________________

Home Phone #: ____________________________

Business Phone #: ____________________________

Prerequisites

1. A copy of driver's license & Vehicle registration
   (New residents may provide a copy of lease or PSE&G utility bill.)

2. Written authorization from local merchant or employer
   for non-resident

3. Non-refundable fee (Rate Changes Effective 3/20/07):
   • Resident: $15.00 per year, per vehicle
     (Seniors: $1.00 per year)
     TEMPORARY: $15.00 (valid up to 60 days)
     TRANSFER FEE: $1.00 (any valid/current permit must be returned to J.C.P.A.)
     
   • Non-Resident: $300 per year (limited to one vehicle - include copy of current W2)
     Temporary: $125.00 (valid for 90 days)

Note: No permit will be issued until ALL summonses pending with the Jersey City Violations Bureau are settled!