CONSENT TO PICK UP
PARKING PERMIT
I, __________________________________________________________________________________,
(Print Name)
Do here by grant the following individual, consent to pick up and deliver my KSU Parking Permit.
____________________________________________________________________________________,
(Print Name of Individual Picking up Parking Permit)
I understand that I assume all liability and cost that might accrue
due to illegal use or misrepresentation of parking privileges of the parking permit that is being picked up.
____________________________________________________________________
(Signature of Permit Owner)
_______________________________
(Date)
____________________________________________________________________
(Wildcat ID#)
________________________________________________
(License Plate #)
________________________
(*State)
*If the vehicle license is a Kansas personalized/special plate, please add the county or type, in addition to the State.
________________________________________________________
__________________________
(Signature of Individual Picking Up Parking Permit)
(Date)
OFFICE USE ONLY
Permit Number: ________________________________
Expiration Date: _____________________
Customer Account #: ____________________________
CI: _______________________________
*Check Identification of Individual Picking Up Parking Permit*