DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER " ■ ) °i 1
(Please print or type)
NAME OF DISABLED INDIVIDUAL: Rd&Si* t5c,*o/tj ■
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
1 3aSi S LooJZ I
(Please print or type current sign location address)
CHICAGO, ILLINOIS (ZIP CODE) (PHONE NUMBER)
REASON FOR REMOVAL: pftSSg^ <^J«vj
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER: ,> . . '
ILLINOIS VEHICLE LICENSE NUMBER:
(Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF
. MY KNOWLEDGE: . . . .... .. ,, . , , ; ,..... ■ ^ „ ; ;.:
r "* (Signature of Applicant) '
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
ALDERMANIC CERTIFICATION: -
. . :'~ ' " ;(Aldermanic Signature)

DO NOT WRITE BELO^JFtfK LINE
: _ ;■' (Ward) r .r!XDate);: ,^T'r :
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES BY
THE ALDERMAN. AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS
INTRODUCED. ... "
The City of Chicago - Department of Revenue
- P.O. Box 803100 J:
ATTN: Disabled Permitting Section
Chicago, IL. 60680-3100
Phone: 312.744.PARK (7275)
~- Revised: 4/24/2019