APPLICATION FOR DISABLED PACKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING IHE FORM
aon-oo;-1|1010|713^
An application will nol be considered complete unless
• All lines of the application have been compieledin full;
• A check or money crdsr for S7C 00 made payable tc the City ot Chi.:ag< is submitted as.payment of the application fee; Please nole: The application fee shall be waived for any person hoiiling a valid, current disabled veterans plate'.
• Disability must be permanent as evidenced by u copy of your valid t'isa. >led placara and/or current vehicle registration submitted al the time ot application:
• Proof of residency, in the form of a copy of your drivE :s license, stat.' idf ntification, or utility bills are submitted at the time of application.
Completed application forms may be returned to: the offke of your aldennan any City of Chicago Department of Revenue facility, or via mail at P.O. Box 8031 DO. Chicago. IL 6068C-3100, ATTN; Cisal led Permitting Section A S25.00 maintenance fee will be billed to you annually. Should you have questions or concern:, pi >ase call our permit processing division at 312-744-PARK (7275).
1. Date of Birth
MO _ D/>.V
__YEAR
iiu _ \jr. r .__ i L'in
O \£> 10 \3 \£ \b
2. State Identification Ni imber
4. Applicant Last Name
T\flpf \L\D\k\
i
Ij. iic Audreys (primary resiCiencRj
SIBEET NUMBEP
1.1
3. Drivers License Number
f SipEriT NUMBEP DIR. STREET NAME Tp|X|T| \(D\ \)J\&\S\T\QH\Z?6. Address where signs will be posted
STREET NUMBER I r»« I STPS?tnamE
Phone Numbers Home
4lg|3[5lc3 l\5\o\7\m\T] Tj^\!,\0\5\^ l\3\0\^ \JL\7
lU/ii Hp S| Mams
L\V\£A1±±„1,1 I .! .I!....¦
- »lf> CDOE
.5
'. niytie inumiu^mo 1 tw"'5
8. Currant Permanent Disabled Placard Number
9. Current License Plate Number
I
i A, i v
ZL
. WARD NUMBER
Business
Registered o
A Hrjgic crod to
Cit;' Stii ker NO.
Seisms
5T-
Relationship to Applicant
Relationship to Applicant
Alternative Parking. ...
Click here for full text