*2022 Forms – Village Of Poquott

Downloadable Forms

Downloadable Forms to print and complete at home, process and pay at Village Hall.

Online Forms

Complete and Process Forms Online.

PARKING PERMIT
Please read rules and regulations section and complete the form and registration upload below. You will be redirected to PayPal payment processing upon submission. You may also download printable form and pay in person at Village Hall at 45 Birchwood Avenue, Poquott, NY 11733.
Resident Information

First Name

Last Name

Address

City

State

Zip

Country (if outside US)

E-mail

Phone Number

Mobile Number

Do you
OwnRent

Vehicle 1 Information

Registration #

Registration Name

Year

Make

Model

Color

Plate#

Do you need to a second vehicle?
noyes

Vehicle 2 Information

Registration #

Registration Name

Year

Make

Model

Color

Plate#

Do you need to register a third vehicle?
noyes

Vehicle 3 Information

Registration #

Registration Name

Year

Make

Model

Color

Plate#

Do you need to register a fourth vehicle?
noyes

Vehicle 4 Information

Registration #

Registration Name

Year

Make

Model

Color

Plate#

Please upload a photo or copy of current registrations for all vehicles you are registering (note: your application will not process without proof of registration).

Upload Registration for second vehicle

Upload Registration for second vehicle

Upload Registration for second vehicle

By checking this box I certify that I have read and agree to abide with the rules and regulations governing the use of Village Property. * *
I agree

You will be redirected to payment processing upon submission.

STREET PARKING PERMIT
Resident Information

First Name

Last Name

Address

E-mail

Phone Number

Mobile Number

Event Information

Date of Event

Event Type

Event Time

Number of Vehicles

Permission is requested to park Resident and/or their guest cars at the following Locations:
California Parking LotWalnut Parking LotVillage Hall Parking LotTennis Court Parking LotVan Brunt TriangleRoadwayOther (please explain)

If Other Selected Please Detail

If any Village Lots were selected please indicate the number of Yellow Parking Passes you are requesting:

Agreement
Submitting an application does not guarantee issuance of a permit. An issued Permit only covers vehicles for the dates in which the permit is authorized in writing (PERMIT MAY DIFFER FROM APPLICATION). All vehicles that will be parked in consideration for this Special Event Parking Application will have a current New York State Department of Motor Vehicle Registration and Inspections certification (as demonstrated with a windshield sticker), all vehicles will be in good mechanical order and will not leak or discharge fluids that may be harmful to wildlife, domestic pets or the environment. Applicant agrees to pay any fines associated with the use of the public properties including the parks, right of ways and roads that is not in compliance with any of the provision contained in Chapters 57, 76, 78, 92, 113, 161, 169 and 173 of the VILLAGE OF POQUOTT Code.

The undersigned does hereby Hold Harmless, indemnify and defend the Incorporated Village of Poquott from any and all liability, loss, damage, expenses,claims, suits or proceedings and cause of actions of any kind and nature arising out of the aforementioned Special Parking Permit.

By checking this box I certify that I have read and agree to abide with the rules and regulations governing the use of Village Property.

I agree

Please type the following alphanumeric combination in the box below

BOAT MOORING
PLEASE NOTE: Effective January 2024 Brookhaven will only accept Mooring Applications online at BrookhavenNY.gov/RecOnline Once you submit your Poquott Mooring Application to Village Hall (with your Poquott payment of $100), we will then forward a copy to Brookhaven and only then will they issue your Brookhaven Mooring Permit.
Resident Information

First Name

Last Name

Address

City

State

Zip

E-mail

Phone Number

Mobile Number

Boat Information

Craft Name

Manufacturer

Year Built

Boat Mooring Location
California ParkWalnut ParkVan Brunt Manor

Boat Registration (if applicable)
State

Number

Expiration

Emergency Owner Assistance Information

Who is authorized to act on your behalf and take whatever measures are necessary to protect your dinghy? (You must list at least one person)
Contact 1 Name

Contact 1 Phone Number

Contact 2 Name

Contact 2 Phone Number

Payment Method

Pay OnlineMail Check to Village Hall
For on line payments please use Paypal button below after submitting the completed online form. Thank you.

I attest that the equipment described above is sea worthy and is in active use, that all information I have supplied is accurate and truthful, and that I accept the terms of this AGREEMENT. I further agree that placement of any vessel on the boat rack will be assigned to me and I agree to remove my boat from the rack prior to December 1st and to immediately comply with any notification I receive from the Village or TOWN OF BROOKHAVEN to remove my vessel for any reason the Village deems necessary. I also agree to pay any fines associated with the use of the Boat Rack that is not in compliance with any of the provisions contained in Chapters 43, 99, 132, 161, 162 and 173 of the VILLAGE OF POQUOTT Code.

I agree

Please type the following alphanumeric combination in the box below

HOUSE CHECK REQUEST
Resident Name

First

Last

Resident Address

Contact Phone Number

Contact E-Mail

House Check Timeframe

Date of Departure

Date of Return

Emergency Contact

First

Last

Phone Number

Email

Will they have keys to your home?
YesNo

Details

Name of person(s) authorized to check your home during your absence

Vehicles that will be parked in your driveway

List any company or service that may be present during your absence

If there is an alarm system please indicate:
Alarm Company Name

Alarm Company Phone Number

Will there be any animals left in the residence?
YesNo
Please type the following alphanumeric combination in the box below