MEMORANDUM FOR TRAFFIC REGULATIONS OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped;
Street, etcj_West 97th Street _
Location, etc::_No. 518 (Ptermit No. 76327)_
Distance or extent: ■ ■
Hours; at all times
Davs: no exceptions
(Odessa Mallett)
LIMITATION OF PARKING PRIVILEGES:
Street, etc._________
Location (or limits):______ _
Distance or extent: _________,_
Time limit:__. . ■ . ■ ■_____
Hours:____. _■ _■___
Days:___--
HOWARD BJBROOKTWS, JR. f Alderman, 2l" Ward '
wis??
2:24F
8653
P. 5 76327
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless:
All lines o< ihe application have been completed in lull:
A check or money order for S70.00 made payable to the City ol Chicago is submitted as payment ol ine application lae: Please note: The application lee shall be waived for any person holding a valid, current disabled veterans olate
Disability must be permanent as evidenced by a copy ol your valid disabled placard and/or current vehicle legislation submitted al the time ol application.
Proof ol residency, in the torm ol a copy of your drivers license, state identification, or utility bills are submitted ;it i'ie time ol application.
Completed application forms may be returned to; the otlice o' your alderman, any Cily of Chicago Department o! Revenue facility, or via mail at P.O Box 803100, Chicago. IL 6068O-3.00. ATTN Disabled Permitting Section. A £25 00 maintenance fee will be billed lo you annually. Should you have questions or concerns, please call our permit processing division -n 3'2-744-PARK (7275)
1 1. Date of Birth
MO
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Applicant Last Name
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2. State Ideniification NumDcr nr Drivers License Number
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i 1 ! ! ____1__i___L
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5. Home Add'ess (primary residence)
.STREET NUMBER UlHl S>MEE'N«*.f,
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First Name
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6 Address where signs will be posted
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7. Prtone Numbers
■7 1 7 -
jimiM.....iiLn_L.j_j_.i_______________1.____.....l
Home : Business
M M^ I 4 1? I? \0\1 \C L .!_,.
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8 Curront Perrnanont Disabled Placard Number
9. Current License Plate Numoor
Rcgisierad to
I Bogisiored to ' City Stickar No.
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Relationship to A;;()iica:'
- Relations'
Relationship ',0 Apt)l>r,m|
10.Description ol Medical Condition and Disability
Alternative Partting: Please note your apodcalion may be denied ii you havo alternative accessible oil sireot parking oi>ik>"s
11.1s more oll-st'ijot parking available at youi primary residence (i.e garage, ear port, driveway, etc.)?
12 II you answered Yes to question 11. please describe JGarage: J Driveway: J Car Pon:
13 Is your oH-stroel oarking accessible? , 3 Yes; jNo Please explain: jtJ^ ft
JOihc-r; (t~K( C'AI- ^frlftpf htl'jj- HSfk ly.*Uj j\*t>-
ation is true and correct. II (he City of C
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14 Affirmation: I hereby affirm thai Ihe above information is true and correct. II the City of Chicago Department of Revenue deicrnn'cs lhal the applicant has falsely represented one or more ol ihe above conditions, the applicant shall bo subject lo a line ol not less i/.ar $100 bui no more than $500. and lhe application shall be denied. I also understand that it 1$ my responsibility to noniy ihe Decaflmeoi ol Revenue of any changasjn the information provided
Signature
Date
qJ^LACARD/PLATE
J COMPLETE
FOR OFFICE USE ONLY
ESIDENCY
ec. 29. 20 1 0 2:24PM
City of Chicago Richard M. Dale;, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107A 121 North LaSalla Street Chicago, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
Jo. 8653^ P. 4 /
December 7, 2010
ALDERMAN HOWARD BROOKINS JR.
WARD 21
9612 S HALSTED
CHICAGO, IL 60628
Dear ALDERMAN BROOKINS JR.:
The Department of Revenue received a request for disabled parking signs to be posted in your ward The application has been reviewed and a survey of the location has been conducted. The Department cannot recommend the application
Provided is the name and address of the applicant, the proposed location of the signs, and the Department's reason for not recommending the application.
Applicant's Name: ODESSA MALLETT Applicant's Address: 518 W 97TH STREET
Reason Not-Recommended: ALTERNATIVE ACCESSIBLE PARKING Explanation: GARAGE AT LOCATION
Appeals must be filed within ten (10) days. Appeal requests must be made in writing and state reasons to support a request for a review. Appeals may be directed to the Mayor's Office for People with Disabilities (MOPD), Disabled Parking Signs Appeal, City Hall, Room 104, 121 N. LaSalle St., Chicago, IL 60602. A decision regarding an appeal will be made within thirty (30) days of the request. Applicants are notified by mail of the final decision.
Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Anthony Gambmo Manager of Parking
cc: Mayor's Office for People with Disabilities
■ UIID1NO CHICAGO TQCETrlSR