04/29/2009 WED 12: 09 FAX 312 742 6999 CITY OF CHICAGO
0002/002
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602
(312)747-4747 (IRIS) (312)744-0471 (FAX) (312)744-2975 CITY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER:
(Please print or type.)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
<^ix?iO LP ■ /k6//f S'{ ._
(Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) (pf) L\l\ (PHONE NUMBER). REASON FOR REMOVAL: M G\J_
715-7 ;o-ol(\
ILLINOIS VEHICLE LICENSE NUMBER:
? foots
3
BUILDING CHICAGO TOUETHBR
(W or V plate)
ILLINOIS DISABLED PLACARD NUMBER: P)Cl S"'] O R f
(Secretary of State)
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 LINE
ALDERMANIC CERTIFICATION:
(Ward)
(Aldennan Signal
(Date)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGNS REMOVAL ORDINANCE IS INTRODUCED .