APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
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An application will not be considered complete unless: ¦ All lines ol the application have been completed in full:
• A check or money prder lor S70 00 made payable to the City ot Chicago is submitted as payment of the application lee: Please note: The application fee shall be waived for any person holding a valid, current disabled veterans plate
• Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
• Proof of residency, in the torm of a copy of your drivers license, state identification, or utility bills are submitted at the time of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-_ __744-PARK (7275). ,
1. Date of Birth 2. State Identification Number
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4. Applicant Last Name
3. Drivers License Number
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5. Home Address (primary residence)
STREET NUMBER Ola I STHEET HH*$ h. .
Ml 1 First Name
,| ZIP CODE
6. Address where signs will be posted|1010|bU>l*|S-|/
, WAHO NUMOEn
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7. Phone Numbers Home m i3t Business ^|3 I i T i I 7 i i i
8. Current Permanent Disabled Placard Number Registered to Relationship to Applicant
9. Current License Plate Number Registered to » City Sticker No. ' 5oi fcSaS Relationship to Applicant
10 Description of Medical Condition and Disability / x*v
Alternative Parking: Please note your application may ...
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