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T-B15 PD02/002 F-401
Cty of Chicago Richard M Daley, Major
Deportment of Revtnne
BcaiUyoa-Hickey Director
atyH*iI,Rocm I07A. 121 Nona LiSalte Street Chicago, Mincij 60602-1288 (312) 747-4747 (IRIS) 012) 7444M7! (FAX) (312) 744-297S (TTY)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER If 3 Z <ia_
(Please print ot type)
NAME OF DISABLED INDIVIDUAL: f)oAa v^* ft o 1J
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED
(Please print or type current sign location address)
CHICAGO,ILLINOIS (ZIP CODE) f.Qf. 3£ (PHONENUMBERS(l7l)73 7^22S3
REASON FOR REMOVAL: X nou^k nj>jo ss LL s \t** I
ILLINOIS VEHICLE LICENSE NUMBER: 2 O t 8 ~S 7___
ILLINOIS DISABLED PLACARD NUMBER: ft (7 9 / ^ ___
(Secretary of Suite Disable Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF BY KNOWLEDGE:
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION
(Ward)
Ihil.
'(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