City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Dlinois 60602 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER I (o / 5~~
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: MoCX\Vu.<\^
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE)/o/)£ 39 (PHONE NUMBER^773j (s?7*S~- 3 <ol 3 REASON FOR REMOVAL: M^^dT_
ILLINOIS VEHICLE LICENSE NUMBER:
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
( Secretary of State Disabled Placard ) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE: Jl(brQ^ Jj&?~
(Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
( Aldermanic Signature )
3Q
(Ward)
(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