Qty of Chicago Richard M.Daley, Mayor
Department of Revenne
Bea Reyoa-Hiekey Director
City Hall, Room 107 121 North UStlle Street Chicago, Illinois 60602 (312) 747-4747 (KiS) (312) 744-0471 (FAX) (312) 744-297$ (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER 5^"^> ,T &
(Please print or type.)
NAME OF DISABLED INDIVIDUAL:Z \/j 1/ rl J4*.f&h ID S 6 4/| REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please prist or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) <^%£^PHONB NUMBER) 77 ^ f?/ #"3.3 £>9 REASON FOR REMOVAL:. T)tl{rjB&'S e__
ILLINOIS VEHICLE LICENSE NUMBER: ^ £> '7_
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBERED j?6>V^3
(Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVEJNFORMATION IS CORRECT TO THE
j_
BEST OF MY KNOWLEDGE/ /i^,^/
Sigrtatu&of Applicant)
(
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
A
(Ward)
Alderrnanic Signature')
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED