MfPUOAIlUN FOR DISABLED PARKING SIGNS 77813 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
misapplication will not be considered complete unless:
• All lines of'the application have been completed in full;
• A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fee; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate.
• Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
• Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at the time of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth MO _ DAY _ YEAR 0\3\ /I g | i?U 2. State Identification Number I I 1T I I IT l 1 1 3. Drivers License Number- PI /I^I^TVI^I^liUUI^I o
4. Applicant Last Name DImM^M I I I I I I I I I I I Ml First Name 5\o\a\y)\h\e\ Mill
5. Home Address (pri STREET NUMBER t>\#.\0\it,\ mary DIR. residence) STREET NAME || ZIP CODE /fid\r\m\ci\i4\cz}\ x/\ \ A A e\ 1 1 1 1 1 1 \&\#\/A3W
6. Address where sig STREET NUMBER (o\&\o\4\ ns w DIR. a II be posted ^ STREET NAME fj\0\r\m\a\ fl\c\\ y| ., WARD NUMBER A\ Ae\ 1 1 1 1 1 1 1 1 II 1 1
7. Phone Numbers Home , 7 I 7 I 3~ A\ A\f~J | G Business
'8. Current Permanent Disabled Placard Number ¦ $£ /307f Registered to Ecfd'...
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