APPLICATION FOR DISABLED PARKING SIGNS 7747 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An appiicsuon witi not bo considered complete unless: All linos of !ho application have been completed in full;
A onset, or money order lor $70.00 made payable to tne City ol Chicago is submitted as payment :.); U:e .;prv ca'.;c'- «■■t; Please noti?. The application fee shall be waived tor any person holding a valid, current disabled veteran.; Dlai;-l.;:s,;ib iiiy rnu^i -j*-: pernvinsnl at Kvidsriccd by a copy of your valid disabled placard and'.-:;!' cuhgh! velii;. :^^-:;;in.o;; -■,-\y-:>\h:-0 ;:;t thi? {'■■^j oi jipp'. jnlien:
Pico* vi re'iicifyiicy. in ihe fern of i\ copy cf your drivers license, slits icientifica'ion. cr t;iii».- tjihr- H'c- ^ii!;:^;:-j s: i' i
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ComuietBO application terms mov be returned lo: 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.«& mai:«er-,-.:-.-;e f>e> will be billed to you annually. Should voti have question.* or concerns, please call our permit processing J'ytstcr, ar V2-744-PARK (7275).
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3. Drivers License Mss.-nbfer
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Aiiemative Parking: Please nolo yon.- application mrfybo denied if voj have alternative accessible off-stiooi pancino options.
J YES
f Is titers off-suect c>ar--.ing available at your primary residence
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I 13. Is your oft •si(qei<p?.irH!ng accessible?
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,4 No Picas;? «Kp«8i.i:
14 Afiirmatio.' I hoieby .iiTnii' tte lh« abovn inlormaiion <s lrue on<l correct. If the City ol Ciicego pfepffrimer.t ol Hev»>»i-.(;- «w>-i.*.-. thai the applicant has falsely represented one or more of ihe above conditions. Ihe applicant shall be subject to a tor of oc« leas «>»>• $100 u-jt no more than V300. sivi irw gppBcation shall be denied. I also undorstgnd that It ■& rav responsif.iiiiv to notifv ttv Ocotsrwr.;.'-Rnvsiiue :Jf nny changes in ;!>•;' mfGnnaiion provided.
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FOR OFFICE USE ONLY
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LACARD/PLATE
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RESIDENCY _J COMPLETE