MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
South Maplewood Avenue
Location, etc:
No. 4234
(Permit No. 72619
Distance or extent:
Hours:
at all times
Days:
no exceptions
ROSALINA GARCIA
Pr
GEORGE A. CARDENAS Alderman, 12th Ward
_ Jan 05 2011 7:52Ph HP LASERJET FAX
773-523-8440
APPLICATION FOR DISABLED PARKING SIGNS 72619 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
A?> application will not bo considered complete unless: Jp \ LcT~) / £?
Aif lines of lhe application have been completed in full; y(f \XSO (7
* A check or money ortter lor $70.00 made payable to trw Cily Chicago is submitted as payrneni o» lhe appifcauor
Please note: The application lee shall be waived for any person hewing a valid, current disabled va-iai.-nf. plalf Disability must be- permanent as evidenced by a copy ot your valid dfeaplatf placard and/or current vuhiuir? wy^t^jiifn siibmiitwi at lhe time of application:
Proof ol restdeitcy. in tha form ol a copy ot your drivel's iioervse. steter iderwificatiort, or ulsfety tallc &fi-: subm»u«d at '.t.e ismo oi applicaliort.
Completed appteatof. forms may be returned to: 1l<e office of your akteimafi, uny City o* Chicago Dcpartmffnl of Rwbm laciiny. or via mail a! P.O. Box 03100, Chicago. lLe068O-'il00, ATTN: Disabled Permitting Section. A $25.00 m<-ii><i5ija.r'>c© tea wiB b» billed to you annually. Should you rtavs questions or concerns, plea%e call our pom*l processinc dfvi&op «l 3i£-74A-PARK (?275|
i. Date of Birth j 2. State identificaikn Number j s. Dr;ve*s Ucer.se Niim
4. Applicant Lest Name I Mi j Ftrst Nam* ;
! Vt I £ J r i
! i .j'.-. '
5. Home Address (primary reskwea)
I5i.2i._im,....£iiftiLL£Lil£iU^^....L_J__1.......ihltilk^lZ.'
fl. Address where -agsra wBi be poetnd j ,-««<fl& '
" ''**"'" ; - i It !
!.....i.........i.....1 . !.....L.....l.__.L_.j i A... if- i
. pnono Numbers Home' j Business !
sts^t ^jm* j confer wa« §
y. priono Numbers Home j ~
JLL7.I.II5£2.LtLfJj,!. i.0;li
_____i...
Currant v;;J.3iT?iani.nt Cfcss&lfcd PU^w Nyrrtoer i ft'i-gistwretf tn R?>J<.K.x.-:ilMp to Appf'C-vi: t!
,/\ ... £ ^ ffl{*\ilr j RoSex\\f\Q CnArCtn______.....\_________cvw^..... ......j
3. CufiK.ni L.a^r-.v.i-Piaio Ntiriib!.:i i Rog*terea to <" City Stoke' Mr:, ■ tii-lMO'-sh'.j,: ic £l:^.a:i'
lO.Descriptim ol M«d»»itCondjiton an^ Otsabilily , (...<*. w Kcq^ U,-'^'^ '
/iias operdWd .If o£\_...Vvt,r________-f^o 4~i^,s.: lonA......ii-^ fe-Hic;
Altt5«iv4livi.( ParKing: fkrtftVA r\o*.e your application r^ny bo denied ii you nave aRamutive &&stm\te oH-s*r«iK oaf kirig opinx>.!>
| n 13 tnere off-sb-wi parkins avaHable w your orimary ftwdenee I YES HL*iO \ ii.ti Q»ag&. car -port, dnvevtay, etc.)?
; \'c '■' you answif.-fpj Yes to Quostion 1"!, istod&e (iewcriire:
'J Gaf*a«r -I tJnveway: Jo.HrPcn. Dotnei; _ j
pa Is your o«-stfeel r^iibng aceewStte? -rv SW'* ^" H C{UAJ--i. M> -RZEi wMt"*^~,
LJ^L_____^^.^ Cair-fc. ana fmtiiwrs , x.......in^^^s,^yd
i<t. Afimnatton: * ne<eby atfim. that the above iniormatiofi is true arvecorrect. I' tlw Ciry of Chicago Dapeitflnani of Revenue deteiinit^s that the appHeant has taisoty mprMeitted one or mora of the above conditions-, the oppifeant snail bo svpiect to a fme ct not tests than StOT; but no mora than $500, and the application shall be denied. I also urtderstanp that it is my respcn&ibilfly to noWy the Oapanmsn. iii Reveruie ol <Kiy criu-nges in the ir-.tarnation providetJ.
Signature.
^tz^^^M^^i..............._............... 0ate:......."StJn./^«^(°
FOR OFFICE US ONLY v / 11 i-0 > OO ^PJcPl ^_ ^
M^FFR ^/PLACARD/PLATE VfcEEIDENCY Q COMPLETE ^jO
Jan <05 2011 7:52PM HP LHSER JETIFRX
THIS PLACARD IS NONTRANSFERABLE. IT IS ILLEGAL TO COPY OR DUPLICATE THIS PLACARD
773-523-8440
p.4
THE AUTHORIZED HOLOEB (UUS1 HE PRESENT. AMD MUST ENTER OR EXIT THC VEHICLE AT THF TIME THE PARKING PRIVILEGES ARU RElNGi USED. UNAUTHORI2FD USE MAV nESULT IN A S500 FINE AND SUSPENSION OF DRIVER'S LICENSE AND/OH REVOCAl'iON OF THE PLACARD.
PERMANENT
BF 42686
M E (EKE.
rliNl' l^l j^^>^^3q^
ih . . J IHt H '
EXPIRES THE LAST DAY OF:
June May Apr. Mar. Feb. Jan.
Jti'.it V/hiif.-»iO'.njt*i;y of Suite
DRIVER'S LICENSE
10 lb* BUttCyev
MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:.
South Maplewood Avenue
Location, etc:
No. 4234
(Permit No. 72619
Distance or extent:
Hours:
at all times
Days:.
no exceptions
ROSALINA GARCIA