APPLICATION FOR DISABLED PARKING SIGNS 74584 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless:
• All lines of the application have been completed in full;
• A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fee; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate.
• Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
• Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at the time of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth MO _ DAY _ YEAR. O I 3 I Jb\ / I 2 \U 2. State Identification Number 2i|5p 2|U^|^^ 3. Drivers License Number
4. Applicant Last Name &\u\s\T\?-\K\ I I I I I I I I I I Ml First Name L |U | 6|V|Ay|A| 'Mill
5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME , .
S\3\W L\y\f^\C\/^I ZIP CODE
6M^ 0
6. Address where signs will be posted
STREET NUMBER
S\3\V|Q|
DIR.
STREET NAME
L\Y\rO\C\/¥¦ WARD NUMBER
7. Phone Numbers
7 i 7 i 3 T
Home
Business
7\7\5T3\9' 9\3l
8. Current Permanent Disabled Placard Number
Registered to
Relationship to Applicant
seep-
9. Current License Plate Number
SZJ/ 7 fV
Registered to
City Sticker No.
Relationship to Applicant
SdAJ J ro L A^d
10. Description of Medical Condition and Disability £> / ^7^* £-/ A <- K/ A> §
Alternative Parking: Please note y...
Click here for full text