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DISABLED PERMIT PARKING RExMOV.iL APPLICATION
FOR SIG>' REMOVAL REGARDING PROHIBITED PARKING EXCEPT I OR DISABLED PERMIT NUMBER bbD- 6^
( Please print oi type. )
NAME Of DISABLED INPrviDUAL: Jtyfc£ LEVY REMOVAL LOCATION OF DISABLED MARKING SPACE REQUESTED:
(fl?*) S. PftXTQM_________
( Please print or rype current jign location address. )
CHICAGO. ILLINOIS (ZIP CCD£)______.'PHCKJE NUMBER)___
REASON -OR REMOVA1.:__POOVE^)______
ILLINOIS VEHICLE LICENSE NUMBER:
i. W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:_______
( Secretary of Sum DmWed Placard )
CERTJJlt ATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF VfY KNOWLEDGE:
( Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WRITE BELOW THIS Lgfr
ALDERMVNTC CERTIFICATION:
( Aldennanic Signature) < W*rd) { Due)
I PS^iif wiSt??8 ^?UCAT'°N IS TO BE FORWARDED TO ' SSS^AT THE TIME THE DISABLED
SIGN REM' )VAL ORDINANCE IS INTRODUCED