MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
South Bell Avenue
Location, etc:
No. 3357
(Permit No. 77449)
Distance or extent:
Hours:
at all times
Days:
no exceptions
ELIAS AVALOS
Jar*. 06 H011 10:01PM HP LASERJET FAX
773-523-8440
P-2
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
77449
An apptteatton wis not be considered complete unless:
All fines of the application have been completed in full;
A check or money order tor $70.00 made payable to ttMj City ol Chicago is submitted as payment of the appiaoatwn foe; Ptease note; The application fee shaft be waived lor any person, holding a valid, curront disabled veterans ptafe-
D!8«bi% must Iw permanent as evidenced by a copy of your valid disabled placard and/or current vehicle wgtelratfori submitted at the time of application;
« Proof of residency, in liw form of a copy of your drivers license, state identification, or utility bate are submitted at the tirno of application.
Completed application forms may tou returned lo: lhe office of your alderman, any City of Chicago Defwrtmertf of Revenue faciSly, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25,00 maintenance fee wrS be billed to you aniuiaiiy. Should you have questions or concerns, plesase call our permit processing division at 312-744-PARK (7275).
1. Date of Birth
MO
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5. State Ittefitrftcatjcn Number
4. Apphoant Last Namo
MjmLioisj....
Ifvtl
3. Drivers Licfirwd Nim>ber ;
Ajl i'M \Z Tl\c lo HT'Z\i M :3I
T Fi rst Nam© ;
I
-i.-
Li......J. I...
5. Home Ariettas 3 (primary resdurwe) srwrer number | aaj j STwre-r wu
J.....teJ..:LiM^
ll_J...JJ_l..l
6. Addn&aa mrtwiio signs w3t bo pasted
■ tlHEEVIMUHSl liW-] K»«EST'*U<E
7. Phoiw Numbers
Home
nisj7jai3iiua
8. Current Permanent Dfcsacie-d Placard Number
JLJ-X-L--!J- - - '
I
Business
I j
___!_____L_
Registered ra
I
Registered to
City Sticker Ne.
JL
Relationship to Applies!*:
__t-j, / V ___________
Relationship to Applicant
10. Description o< Medical Condition end Disability Alternatrvo Parking: Ptawsooote your application may bo deniedM
iC
i t. Is there off stiaet parking available at your primary residence
{I.e., garafle. car port, dtlwway, etc.)? 12. ff youjanstverad Yes to qus&tion 11, please describe:
SlKSarBge; □ Driveway. □ Car Port; U Other:
! have aftemativo accessfoto olf-strwt parking opttorvsr^^*
a*£s □ no 1
t3. Is your off-street psfftjing acemrtHe? Q Yoa, SH"Ja Pteaso explnnr.
Urn
14 Attirfnatlon: 1 hereby alflrm tftat the above intormatiefi is ;rue and correct. II the City ot diicago Department of Rev&rwo ctele»rn.v)e9 that the applicant has falsely represented one oi more ot trie above conditions, the applica/il shall be subject to a fine df not less than $100 but no more than $500. and the application shall be dented. I also understand that it is my responsibility to notify the Department ol Revenue of any changes in the information provided.
Signature .
Date.
........
"^^ACARO/PLATE «^RES1
FOR OFFICE USE ONLY jsFEE
RESIDENCY □ COMPLETE # Jf)
jar- 06 2011 10; 02PM HP LASERJET FAX
773-523-8440
p.3
HE AUTHORIZED HOLDER MUST BE PRESENT AMD MUST PfJTPB nu cv.T J1S CHICLE AT THE TIME THE PARKING P^ViLs Jl JJ I^r nl^
>Wvr.n-B LICENSE AMD/0 fl REvOCAriOM OPTHE PLA-AflU °F
PERMANENT
BA 44110
HE LAST DAY OF:
une May Apr. Mar. Feb. Jan
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"■DfllVEiTS LICENSE
u *.-Al 42-2004-2113
tW*«G0 it.6»M8
(tale $'«"■«> lbs MN Eyct
labled Parking Application Payment Stub
;ase make check or money order payable to the City of Chicago
TOTAL AMOU
MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:.
South Bell Avenue
Location, etc:
No. 3357
(Permit No. 77449)
Distance or extent:
Hours:
at all times
Days:
no exceptions
ELIAS AVALOS