MEMORANDUM FOR TRAFFIC REGULATIONS
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:_South Clyde Avenue_
Location, etc:_No. 7527_(Permit No. 77495)_
Distance or extent:_
Hours:_at all times_
Days:_no exceptions_
CATHERINE WILLIAMS
MICHELLE A. HARRIS Alderman, 8th Ward
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
77495
An application will not be considered complete unless:
• All lines of the application have been completed in full;
• A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fee; Please note: The application fee shall be waived foriany 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 form 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
MO _ DAY
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2. State Identification Number
3. Drivers License Number
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4. Applicant Last Name
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First Name
5. Home Address (primary residence)
STREET NUMBER
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DIR. STREET NAME
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6. Address where signs will be posted
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1. Phone Numbers
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Business
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8. Current Permanent Disabled Placard Number
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Registered to
Relationship to Applicant
9. Current License Plate Number...
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