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
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
\^ ^LaJaC J ., _:__!___I___;__L...L._J_.l__LJ.i_A... 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\_____________................. \9. Currenl License Plalo Number
Registered lo ; City Shckci No. Relationship ici.''|".i>!»''-'i,,i
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