APPLICATION FOR DISABLED PARKING SIGN& PLEASE READ THE FOLLOWING CAREFULLY
74244
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BEFORE COMPLETING THE FORM r~*-*~**)—
a.-, application will no? be considered complete unless: T" "} ' -¦
A« lines of the application have been completed in full. '¦ 0 J4*^--'
A chock or money order for $70.00 made payable to the C;ry of Chicago is submitted as payment of the appticn'on .j Please note-' The application fee shall be waived for any person holding a valid, current disaoled veterans p!at«i. y »v Disability "lust he permanent as evidenced by a copy of your valid disabled placard apd'or currni; vehicle n "v ,suited si the f.j, ;-,<:¦ o? application: / Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at me time of applicatior.
^mplsied application forms may be. returned to: the office of your alderman - any City of Chicago-Department of FtevBRut
facility, or via mail at P.O. Box 803100. Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 main* fee will be biilec to yon annually. Should you have questions ot concerns, please call our permit prvvissiriq div&k/r 74-i-PARK {?2?S}.
Dale of Birth
2. State iOentifirsiiion Numfctn
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3. Driveis License' Nurnbtsi
V •Arpiir.ant Lasl Name
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First Name
5 Heme Address (primary residence).
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fi. Address where signs will be posted
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/. Pnone Number:; ¦ Home . Business
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.•r«>«t Permanent Ow-soted Placard Numbc
Registered to
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8. Current (license Piarc Nurnboi
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Ratatiansi up to Apptk>8rv \ .
Registered to'
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,:10.Description.ol Medical Condition and Disability. "fy Q.uJq it 1<$Cl fflA. ^ c?j. j Ai'.omyiivc Parking:
ng: Please note your application may be.deniad rf you hive'afterhative accessible bff^treet ...
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