DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER L V ~i %
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: (\(\(fOl Pv f^CZ PlCl6?| REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
( Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) \ (PHONE NUMBER) T"1^- LoYS M 136 REASON FOR REMOVAL: mo^t _
ILLINOIS VEHICLE LICENSE NUMBER: K 63 53
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER: j£>(L /tff3 I'c?
( Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE: H-Oa m "Ou g.
( Signarure of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
-7~
(Aldermanic Signarure ) ( 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