APPLICAnON FOR DISABLED PARKING SIGNS 768^79 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless:
All lines of the application have been completed in full;
A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fie; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plale. J
Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at thes time of application. ;
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P:Cv Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenaqbe lee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275). ;
1. Date of Birth oi4 i / i3i 5\0 |
2. State Identification Number £ 1 i 1T11iTlll c |
J£f Drivers Licepse Number ^12. Slo'feH'H. I7T1 ISI&io |
4. Applicant Last Name Di^M/h i m i i i i iii |
Ml |
First Mame K'C6\lH)\ ri 1111 |
|
5. Home'Address (primary residence) &\rMYMl%7iMMZ\£il)\Mub\ i i i i i i i I£i3i£.k3 |
5 |
6. Address where signs will be posted SIBEET NUMBER I DiR,| STREET NAME . |
1 WARD NUMBER %7?\- i l l I l M il \0\W) |
7. Phone.Numbers Home 1 7 17 i3T£i£d.#^ |
■ 1 |
Business 1.1 T 1 l- T 1 1 ■ I !" |
8. Current Permanent Disabled Placard Number |
. Registered to |
Relationship to Applicant ' |
a- |
|
|
[9/Current License Plate Number f \ |
Reaistered to |
Citu Rfinkpr Nn P . .6o'.o 17^-8 |
Relationship lo Applicant |
|
|
|
|
1D. Description ol Medical Condition and Disability - - '■ |
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options: |
11. Is there off-street parking available at your primary residence £jLYES □ NO ■ - y * (i.e garage, car port, driveway, etc.)? ty/)^ Jtf ffljJ&F) "72? P/l&C ^WXT" |
12.If you answered Yes to question Irtvj-jtoase describe: I □ Garage; □ Driveway; x^jfcar Port; -□ Other?.- fJOT ffil6U}f^lO 72) fftPtL \ |
13. Is your off-streetpftrking accessible? □ Yes; 3wo. Please explaini - |
|
|
|
|
|
|
|
|
14. Affirmation: t hereby affirm"that the above information is true and correct. If the City of Chicago Department of Revenue.determines/ that the applicant has lalsely represented one or more of the above conditions, the applican: shall be subject to a fine of not less than { $100 but no more than $500, and the application shall be denied. I also understand that it is my responsibility to notify the Department pj Revenue of any changes in the information provided.
Signature .
Date
10-/ 14 / 2M 0
^7
FOR OFFICE U3£ ONLY
UdlE'Q IT.02 80 qaj
City of Chicago Richard M. Daley, Mayor
Department of Revenue
BeaRcyna-Hickey Director
City Hall, Room I OTA 121 North USalle Street Chicago, Illioois 60602-1288 (312) 7474747 (ERE) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
BUILDING CHICAGO TCGETBER
December 29, 2010
EISHO OSHANA 2831 W SUMMERDALE CHICAGO, IL 60625
Dear Applicant:
The Department of Revenue received your request for disabled parking signs. The application was reviewed and a survey of the location was conducted. The Department cannot recommend the application.
The Department's reason for not recommending the application is:
Reason Not-Recommended: ALTERNATIVE ACCESSIBLE PARKING Explanation: GARAGE AT LOCATION
Appeals must be filed within ten (10) days. Appeal requests must be made in writing and state reasons to support a request for a review. Appeals may be directed to the Mayor's Office for People with Disabilities (MOPD), Disabled Parking Signs Appeal, City Hall, Room 104, 121 N. LaSalle St., Chicago, IL 60602. A decision regarding an appeal will be made within thirty (30) days of the request. Applicants are notified by mail of the final decision.
Should you have any questions or require additional information, please contact us at (312) 742-7434.
Very truly yours,
Anthdny Gambino Manager of Parking
froee-S9z.-Eiz.
OfrP-iem WdT2:s 1102 80"qaj
February 8, 2011
Mayor's Office for People -with Disabilities (MOPD) Disabled Parking Signs Appeal, City Hall, Room 104 121 N. LaSalle St Chicago, EL 60602
To Whom It May Concern:
I am Rarao Seferaj, the Oshana Family landlord. They rent an apartment at 2831 W Summerdale ave. Theyt recently applied for a Disabled Parking Sign and were denied. I have a 2 car garage, but it is already occupied since I have 2 cars already in it. The only place for them to park ia on the street, in front of the house. Please approve the disabled parking sign for them, living on a aide street, especially this time of year, it is very difficult for them to find a parking spot.
Thank You
\o Seferaj
*0BE-G9L-£LL
1102 80 qaj
Feb 08 2011 5:21PM warcMO 773-769-3804 P-5
aunp tew 'Jdy qoj 'tier
lN3NVIAJU3d 4
Gu:'j'>ic =mj io ric:tjT:'i:>A:4:i -jconv 3sn30ti s.ea/uno .ii, >«-«>! isa'ir.s C'n aim ooss * ni ncv.'jki ;.wi 3-3>l uuzifcHj^irwufi
'j^T.n f^ii'S^ ^H*7 '==E">2-;i.\:.,-.;d .">IJI-t)^cJ DHi. 3'."J _L 3MJ. /.r 3i:Mir:J.*. :JH1
adv^>vid smxaj-vondnci bo Adoo 04~iv03-nt st ju I NOHOW Nl SI31DIH3A3yOJ39 3AOI/\!3d
i uun bunncnui
>.£MaaCMK.M£>J .TJ'ilL'.Lfll.'^IT.rlii.Wl.iJI-'.xISll'.Kiyin, ■■-.VtBiST-Ct.tl
5204 NORTH LINCOLN AVENUE - CHICAGO, ILLINOIS 0O023 PHONE: 773-S6V6459 TO VERIFY CALL 773-374-2801
raMrrrcK
UUIVIHUm I T
/Q-ZB2B 719
COftUS BANK OHCAQO.IIJJNOIS
No.P 841561
10/13/2010
PAY TO THE ORDER OF
CITY OF CHICAGO
SEVENTY AND 00/100 DOLLARS Mfl NO fflJM) If LOGT IU
;:wLMBCNTOPrHiiMsimuwjPMBOKSi^imaeEoiN«wtBWE>< . pie piMotw.Ai^ncREvnu. it a m CHmoeo.pan two .amice. /
S*«WniBUm'.t>.Tm*^ the fume of the
riWlB UNO ABSIMSTOTM: RESKMMlUTY.POfl *Mf &VEM9-----'---
iiMKlttlll
o
CD
ro o
ro ro
"0
3
E 01 ->
a. o
^]
CO
I
v] 01 CO
I
CO CO
□
TJ 01