The application form shall contain the name and address of the applicant; the year, make, and license number of the automobile owned by the applicant which is authorized to use the private parking space; and a signed statement from the applicant, that he or his spouse resides at the address given in the application and a signed, certified statement from a medical doctor attesting to the handicap of the applicant and the need for a parking space, that he or his spouse owns the listed automobile, and that he is unable to provide adequate off-street parking. Should the automobile or its license number change while the permit is in force, it is the applicant's responsibility to have it changed on the application.
