3:29PM HP LASERJET FRX
312 768 5323
11:17 FR COPY ROOM 312 768 5823 TO 917733488480 P. 01/02
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER___
( Please print or type.)
NAME OF DISABLED INDIVIDUAL:,
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
1031 kf.£LU<f_______
( Please print type current sign location address. )
CHICAGO, ILLINOIS (ZIP CODE)_(PHONE NUMBER)__
REASON FOR REMOVAL: fy/JJUS ' d T__
ILLINOIS VEHICLE LICENSE NUMBER:__
(WorV plates)
ILLINOIS DISABLED PLACARD NUMBER:
( Secretary of State Disabled Placard )
CERTIFICATION: THE ABOVE INFORMATION^ CORRECT TO THE BEST OF MY KNOWLEDGE:
"E INFORM ATiONlS CORK EC
( Signature of Applicant )
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE^ ALDE^MANI^CTSRT^
( Alderrnanic Signature ) ( Ward ) ( Date )
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES. BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED