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;7734343889 #2/2 T-BI5 POOZ/OOZ F"<01
Q ty of Chicago Richard M. Daley, Major
Department of Re»«i»e
QcaJtcyoa-Hickey Director
CityHidl,Roeml07A 121 North LiSa)lt Street Chicago, Llinoif 60602-1288 (312) 747-»7«7 (IRJS) 012) 74<UW71 (FAX) (312) 744-2375 rm)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER it 3 .3 *ip_
(Please print or type)
NAME OF DISABLED INDIVIDUAL: f)r> \ o ft * U
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED
(Please print or type current sign location address)
CHICAGO,ILLINOIS (ZIP CODE) l.OL 36 (PHONENUMBER^f77B)73 7-90.2S3
REASON FOR REMOVAL: X U^. n**o as UL s Vrgo I
ILLINOIS VEHICLE LICENSE NUMBER: 301 g li 7___
ILLINOIS DISABLED PLACARD NUMBER: ft F 9 / ^ ?ff_
(Secretary of Sure 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 WRTTE BELOW THIS LINE
ALDERMAN1C CERTIFICATION
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED