Feb .pe^SOU 3:29PM HP LASERJET FAX
p.2
312 768 5823 JUN 11 2007 11:17 FR COPY ROOM
312 75S 5B23 TO 917733488480
P.01^02
j 0< Chicago
hard M. Dnlcy, Mayor
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Reyna-Hickcy sctor
, Hall. Room 107 North laSalle Strcti cage, Illinois 60602 21 747-4747 (IW5) 2) 744-0471 (h'AX) 2) 744-2975 (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER__
( Please prim or typt. )
NAME OF DISABLED INDIVIDUAL: O^HJCsfch" \ Os- G rc^yy^O^r I K^X- iC I S REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
( Please print or type current sign 1
CHICAGO, ILLINOIS (ZIP CODE),
. location address. }
_(PHONE NUMBER),
REASON FOR REMOVAL: fo&U%ld- ]\f?TY*A*^ fatf^
ILLINOIS VEHICLE LICENSE NUMBER:____
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER: Ziff&tf fa_
( Secretary of Stale Disabled Placard >
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE £_,
ALDERMANIC CERTIFICATION:
(Aldermanic 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