MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
South Maplewood Avenue
Location, etc:
No. 4234
(Permit No. 72619
Distance or extent:
Hours:
at all times
Days:
no exceptions
ROSALINA GARCIA
Pr
GEORGE A. CARDENAS Alderman, 12th Ward
_ Jan 05 2011 7:52Ph HP LASERJET FAX
773-523-8440
APPLICATION FOR DISABLED PARKING SIGNS 72619 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
A?> application will not bo considered complete unless: Jp \ LcT~) / £?
Aif lines of lhe application have been completed in full; y(f \XSO (7
* A check or money ortter lor $70.00 made payable to trw Cily Chicago is submitted as payrneni o» lhe appifcauor
Please note: The application lee shall be waived for any person hewing a valid, current disabled va-iai.-nf. plalf Disability must be- permanent as evidenced by a copy ot your valid dfeaplatf placard and/or current vuhiuir? wy^t^jiifn siibmiitwi at lhe time of application:
Proof ol restdeitcy. in tha form ol a copy ot your drivel's iioervse. steter iderwificatiort, or ulsfety tallc &fi-: subm»u«d at '.t.e ismo oi applicaliort.
Completed appteatof. forms may be returned to: 1l
c© tea wiB b» billed to you annually. Should you rtavs questions or concerns, plea%e call our pom*l processinc dfvi&op «l 3i£-74A-PARK (?275|
i. Date of Birth j 2. State identificaikn Number j s. Dr;ve*s Ucer.se Niim
4. Applicant Lest Name I Mi j Ftrst Nam* ;
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5. Home Address (primary reskwea)
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