APPLICATION FOR DISABLED PARKING SIGNS 73362 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless:
All lines of Ihe application have been completed in full.
A check or money order lor S70.00 made payable to the City ol Chicago is submitted as payment o! the .'jniVicaiion tee. Please note: The application fee shall be waived for any person holding a valid, current disabled veterans i.iK'iie
Disability must be permanent as evidenced by a copy of your valid disabled placard a'id-'or current vel'icle-ec.is!:."il!on submitted at the time of application:
Proof of residency, in the form of a copy of your dnvers license, state identification, or utility bills ate sutjnnliiid ;ii lifetime of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Depanmeni oi R.;v£:>uie facility, or via mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN: Disabled Permitting Section A S25 00 m.nnie-wincc fee will be billed to you annually. Should you have questions or concerns, please call oui permit processed division <v, 312-744-PARK (7275).
1 Date ol Birth ! 2 Slalc Identification Nurnbci .i D'ivuis Lci.'nsc Number
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Twi [ First Name
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j 4 Applicant Last Name
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I 5 Home Address (primary residence)
! j .1 'C i ?! ; ^>iV :e I r no ,n______________........................................J6. ...0.h . I L
! 6. Address wheie signs will bo posted . . . .,.,
J STREET NllMBtR | !IIH I SIHEEMIAME 1
i v ;!6J^LL-L*^i^ ............ I fc
j 7. Ptione Numbers Homo ! Business
1 \1 i'S ~ I \>\ i \ 16.....:_S....Ls
8 Current Permanent Disabled Placard Number Registered m RclaiunsniiApfun-.-ii':
BO 1W\_____________................. \<hecL* L^A^di)1 .............._
9. Currenl License Plalo Number
Registered lo ; City Shckci No. Relationship ici.''|".i>!»''-'i,,i
iy_ 'J'..............
\/b*.y/»pa/ ^ per,
10 Descnption ot Medical Condition and Disability
_._____Udh^_________ScM^^s_______________________....
ise nc
l Alternative Parking: Please note your application may he denied ii you have ait^uvitivc accessible otf-^r-oo' pail"":.' ^li-v-
: 11.1s there olt-stroot parking available at your primary residence ^tES
j_ (i.e garage, car pon. driveway, etc.)?
I 1? II you answered Yes to question 11. please describe //j r<-- </ ;i»> k.~-: "A ? -/-... (. A .,'^7-^
"4--^lGarage: J Dnvcway: J Car Pen: J Other- ke ±'*<'P -tk,* cj r>^<} < atK-'ii i/j « -
,--.-.-j--=J-.-1 T-fl--^^ ^**\f. I»"
j 13 Is your oH-stroot parking accessible? .>ivwl( R/-r ^ icJt? 5+r<-<-+ <y 1 /i^we '"' i~Ct Z-<> 'hfr1 I't <■
, J Yes. Ol No Please explain fUi.N \ ^lU^f \ C_ . -Hit-* ^><" V, iic-^i/'» u ^ r^'V" ^
14 Atlirmalion: I hereby allirm lhal the above information is true and correct II Ihe Cnv ol Chicago Depanmcni ol Revenue dijiorrnm.--. that Ihe applicanl has falsely represented one or more ol Ihe above condilions. the applicant shall be subieci to a lino ol no' es- '.'mm $100 but no more than $500. and the appiicalion shall t>e denied. 1 also understand thai it is mv rcsoonsibihiv lo noiil\ th«:- Department 01 Revenue of any changes m Ihe information provided.
Signature >&2jJ^tl*S**- r*4LCis<s&*- Date
FOR OFFICE USE ONLY "\~7\7 C'H^C h ^ fa
^TFEE yyLACARD/PLATE (^RESIDENCY J COMPLETE fl-yo^-
December 3, 2010
ALDERMAN FREDDRENNA LYLE WARD 06
406 E 75TH STREET CHICAGO, IL 60619
Dear ALDERMAN LYLE:
The Department of Revenue recommends installation of djsabled-parking signs as described below. The application has been,revie'wed and a survey of the location has been conducted. Sjnce the applicant has met the requirements outlined in the Municipal Code, the signs will be installed.
Provided is the name and address of the applicant, the exact location proposed for the signs, and the permit number assigned. Please introduce an ordinance to post residential disabled parking signs at the location recommended, if one has not yet been introduced.
Applicant's Name: SHECHIA C HEARD
Applicant's Address: 8207 S VERNON
Address/Location ot Signs: 8207 S VERNON
Permit Number: 73362
Work Order Number: H10-1378
If the proposed ordinance is not passed within four months after its introduction, the permit shall be revoked and the restricted parking signs removed. Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Manager of Parking
Enclosure: Disabled Signs Application
City of Chicago Richard M. Daley, Mayor
December 3, 2010
Department of Revenue
Bea Reyna-Hickey Director
City Hal I, Room 107 A 121 North LaSalle Street Chicago, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 fTTY)
BUILDING CHICAGO TOGETHER
SHECHIA C HEARD 8207 S VERNON CHICAGO, IL 60619
Dear Applicant:
The Department of Revenue has recommended installation of disabled parking signs near your residence. Based on this recommendation, the signs for your restricted parking space will be installed. However, your application must be approved by City Council. If the proposed ordinance is not passed within four months after its, -----
introduction, the permit shall be revoked and the restricted parking signs removed.
f
The parking permit must be renewed annually. The fee is $25.00. A renewal notice will be mailed one year from the date the signs are installed.
Please be advised that you are required to report any changes to the information provided on your original application to the City of Chicago Department of Revenue. You are also required by City law to notify the Department if you no longer meet the following permit qualifications:
* You must hold either a valid, current disabled veteran's state registration plate or permanent person with disability license plate, permanent parking placard or device authorized by the Illinois Vehicle Code;
* Any vehicle parked by you or for you in the designated area must bear the disabled license plate, permanent disabled parking placard or devices issued to you by the State of Illinois;
* You must continue to reside at the home address listed on the original application.
A residential disabled parking permit will be issued to you by the City of Chicago. It must be placed on the right side of the dashboard. Only qualified vehicles displaying the permit are authorized to park in your restricted parking space. The permit number must be visible from outside your vehicle. The permit will be installed at:
Address/Location of Signs: 8207 S VERNON Permit number: 73362
Should you have any questions or require additional information, please contact the City of Chicago's Helpline at 312.742.7434.
Very truly yours,
Copy: ALDERMAN LYLE