APPUCATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWINGi CAREFULLY BEFORE COMPLETING t^E K>RM
72706
An application will not be considered complete unless:
• AH lines of the appfacafion have been compteted in full;
¦ A check or money onier for S70.C0 made p'iayaibia to the City of Chicago te submitted as payment of The applicator* fse: Pi*asr; now: Trio application fee shall Be waived for any person holding a valid, current diri&bled veterans plate. Disability must be permanent as evidenced by a copy ol your valid disabled placard and/or current voliirto regiairuiion submitted at the lime oi application;
• Proof of residency, in the form of a copy of your drivers !lccf>3_. tjrtaite' irjf^tllicatbn. ot utility bids are submitted at ?h
Compl«li»d. application forms may be returned to; the office of your alderman, any City ol Chicago Department of Revftnuip facility, or via .mail at P.O. Box 803100. Chicago. 'IL .6G680-31OO. ATTN: Disabled Permitting Section. A $25 OC ma*ntewvic4i fee will be bided to yoy annually. Should you tiave auestions or concerns, please call our permii orocessino rjiviwon at 312-7.54-PARK {7275).
i, o' Birth
\ Z. State Idcnilfiraiicn Number
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i. Applicant laat Name
1 3 Drivers Ucenso Number
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5. Home Addies* (primary nwiconca)
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6. Addmos whom sign*\vtHbfiposted .-tai >unqc^ : ' urn. | m'nrr.THitve
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7. Ph'jnQ Numbers
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9. Current License Plate Numbor
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Hugisiered to Pw.viir.«is^ip lo Applicant
Registered to
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10. Description ot Medicikl Condition and DisabHin
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Altornrjiivr? Parking: Pioasn nolo your application may be...
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