Berkeley, CA · Alameda County
In-Home Care Residential Preferential Permit Renewal Medical Affidavit
Berkeley residents applying for an In-Home Care Parking Permit use this affidavit to provide medical and physician information and sign a declaration.
What this form is
This affidavit supports an application for a Berkeley In-Home Care Parking Permit. It asks for the applicant’s name and address, residential parking area, whether the disability is permanent or temporary, and the physician’s contact details. The applicant signs and dates a declaration that the information is true and correct under penalty of perjury.
Who needs it
A Berkeley resident applying for an In-Home Care Parking Permit who requires health care while the Residential Parking Ordinance is in effect needs this affidavit.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
No notary is required; the applicant signs and dates the declaration, which states under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Affidavit
Download the In-Home Care Residential Preferential Permit Renewal Medical Affidavit.
- 2
Complete The Form
Enter your name, address, parking area, disability status, and physician’s contact details.
- 3
Sign And Date
Sign and date the declaration that the information is true and correct under penalty of perjury.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What information does the In-Home Care Medical Affidavit ask for?
- It asks for the applicant’s name and address, residential parking area, disability duration, physician’s contact details, and the applicant’s signature and date.
- Do I need a notary for the In-Home Care Medical Affidavit?
- No. The applicant signs and dates the declaration, which is made under penalty of perjury; the form does not require a notary.
- How do I submit the In-Home Care Medical Affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This In-Home Care Residential Preferential Permit Renewal Medical Affidavit doesn’t need a notary — but if you have another Berkeley form that does, a commissioned online notary can help.