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2. Apply in person at or mail stamped self address envelope to:
   Vernon Township
   Prairie View Metra Station
   3050 N Main Street
   Buffalo Grove, IL 60089
   Phone: 847-634-4600
3. Type of Permit Requested

   1. Monthly
   2. Quarterly
   3. Semi-Annual
   4. Annual
5. Name and Address
6. Home Phone
7. Business Phone
9. Make & Model Car 1
10. License Plate Number
11. Make & Model Car 2
12. License Plate Number
14. Make & Model Car 3
15. License Plate Number
16. *Please list license plate number even if you have had a permit in the past.
18. If applying by mail, be sure to include a self addressed, stamped envelope.
20. -------------------------------------------------- For Township Use Only Below --------------------------------------------------
22. Permit Number
23. Fee Collected
24. Date
25. Cash or Check Number
27. _______________
28. _______________
29. _______________
30. _______________
Leave This Blank:


31. Print Only

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