City of Chicago Richard M. Daley, Mayor
Department of Revenue
BeaReyria-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 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 *S*5V~l
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: q\q -6 f ~V 6i!~Tir 4LfX)\ rlldr REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address. ) CHICAGO, ILLINOIS (ZIP code) ItjploS / (PHONE NUMBER)~n 3' M 14- 3 3pM-REASON FOR REMOVAL:_P^tWeA_
ILLINOIS VEHICLE LICENSE NUMBER: tQS5^5M5
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER: F> ^ 3^1 %
(Secretary of State Disabled Placard ) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:_
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LI
ALDERMANIC CERTIFICATION
(Aldermanic Signature) /-/</'//
(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
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