"Accessible Parking Request Form" - Nebraska

Accessible Parking Request Form is a legal document that was released by the Nebraska Department of Administrative Services - a government authority operating within Nebraska.

Form Details:

  • Released on May 23, 2017;
  • The latest edition currently provided by the Nebraska Department of Administrative Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Administrative Services.

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·
NEBR ASK/\
DEPT. OF ADMINISTRATIVE
SERVICES
State Bui ld ing Division
__
,.,_,,.
";:;J
·-·-·.
Accessible Parking Request Form
Please return this form to: S
N
AS/SBD P
S
TATE OF
EBRASKA
ARKING
ERVICES
AS/SBD P
S
O
S
O
B
ARKING
ERVICES
MAHA
TATE
FFICE
UILDING
1526 K S
, S
200
1313 F
S
TREET
UITE
ARNAM
TREET
L
, NE 68508
O
, NE 68102
INCOLN
MAHA
402-471-3191
402-595-2115
The State of Nebraska is committed to meeting its obligations pursuant to Section 504 of the Rehabilitation Act of 1973 as
amended and the Americans with Disabilities Act of 1990 as amended.
Eligibility for accessible parking is based upon the applicant’s current needs, which could be of a permanent or temporary
nature. This may require a review of the applicant’s current medical information.
To be completed by the applicant (Please print):
Employed by Agency: _______________________________________________________________________
Employee requesting an accessible parking permit for: _____________________________________________
Employee ID#: ______________________________________________________________________________
Email: ___________________________________________________________________________________
Please include a copy of the DMV handicap hangtag/permit that was issued to you.
Please provide a statement of your need for accessible parking:
Signature ___________________________________________
Date:________________________________
Tuesday, May 23, 2017
St of NE, AS-Building Div: accessible parking request form 5-2017
-----
·
NEBR ASK/\
DEPT. OF ADMINISTRATIVE
SERVICES
State Bui ld ing Division
__
,.,_,,.
";:;J
·-·-·.
Accessible Parking Request Form
Please return this form to: S
N
AS/SBD P
S
TATE OF
EBRASKA
ARKING
ERVICES
AS/SBD P
S
O
S
O
B
ARKING
ERVICES
MAHA
TATE
FFICE
UILDING
1526 K S
, S
200
1313 F
S
TREET
UITE
ARNAM
TREET
L
, NE 68508
O
, NE 68102
INCOLN
MAHA
402-471-3191
402-595-2115
The State of Nebraska is committed to meeting its obligations pursuant to Section 504 of the Rehabilitation Act of 1973 as
amended and the Americans with Disabilities Act of 1990 as amended.
Eligibility for accessible parking is based upon the applicant’s current needs, which could be of a permanent or temporary
nature. This may require a review of the applicant’s current medical information.
To be completed by the applicant (Please print):
Employed by Agency: _______________________________________________________________________
Employee requesting an accessible parking permit for: _____________________________________________
Employee ID#: ______________________________________________________________________________
Email: ___________________________________________________________________________________
Please include a copy of the DMV handicap hangtag/permit that was issued to you.
Please provide a statement of your need for accessible parking:
Signature ___________________________________________
Date:________________________________
Tuesday, May 23, 2017
St of NE, AS-Building Div: accessible parking request form 5-2017