MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
East 83rd Place
Location, etc:
No. 1637
(Permit No. 77471)
Distance or extent:
Hours:
at all times
Days:
no exceptions
CARLEAN WOODS
MICHELLE A. HARRIS Alderman, 8th Ward
01/05/2011 WED 15:08 FAX
21003/00|1010|
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
77471
An application will not be considered complete unless:
• All lines of the application have been completed in full;
• A check or money order tor S70.00 made payable to the City ol Chicago is submitted as payment ol the applicalion fee; Please note: The application fee shall be waived for any person holding a valid, current disabled veterans piale
• 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 form of a copy ot your drivers license, slate 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
MO _ D*r
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4. Applicant Last Name
2 State Identification Number
i i|1010|_L__
3 Drivers License Number
Ml J First Name-
5. Home Address (primary residence)
STREET NUMBER | HIM ISTHttT NAME /
6. Address where signs will be posted
STREET NUMBER 1 illH.
STHEtT NUMBER 1 iHH. I__JIH££T HW):
7. Phone Numbers 1 ft
Home
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8. Current Permanent Disabled Placard Number
9. Current License Plate Number
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Business
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