MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
East 83rd Street
Location, etc:
No. 1136 A
(Permit No. 71018)
Distance or extent:
Hours:
at all times
Days:
no exceptions
WAYNE GILES
MICHELLE A. HARRIS^ Alderman, 8th Ward
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
7101E
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 tnJhp nity.-oU^faiftftgn k Miinniiii'ii ,v, pnyrriHaLnf }hp application fee; Please note: The application fee shall be waived for any 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
2. State Identification Number
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3. Drivers License Number
4. Applicant Last Name
Cri \ i CiFiSi
Ml
First Name
WlA-iy 1M|£T
5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME
bIHfcbl NUMbtH UIH. SIHbtl NAMt , --i ._
[\\\3\b\h\E\Y\Z\R\<L\ Is! /
6. Address where signs will be posted
STREET NUMBER . DIR. STREET NAME
oiolli itUWIDCn i uin. or n l. i_ ■ i vi c ■
., WARD NUr^BER
Business Q,Q1is
7i 7 |3t9i 9ioVr4iS>i-3i5
7. Phone Numbers
7l7i3T
Home
7i4
/l /
8. Current Permanent Disabled Placard Number ht<S76(e 5» |
/ Registered to . |
Relationship to Applicant |
|
i |
|
9. Current License Plate Number |
i Registered to |
City Sticker No. |
Relationship to Applicant |
|
1 |
|
|
|
|
|
|
10. Description of Medical Condition and Disability
i dejnied if you have alternative-arc
Alternative Parking: Please no~te~your application may be defied if you have alternative .accessible off-street parking options.
11. Is there off-street parking available at your primary residence (i.e., garage, car port, driveway, etc.)?
□ YES NO
12. If you answered Yes to question 11, please describe:
□ Garage; □ Driveway; □ Car Port; □ Other:
13. Is your off-street parking accessible? □ Yes; JS^No. Please explain:
14. Affirmation: I hereby affirm that the above information is true and correct. If the City of Chicago Department of Revenue determines that the applicant has falsely represented one or more of the above conditions, the applicant shall be subject to a fine of not less than $100 but no more than $500, and the application shall be denied. I also understand that it is my responsibility to notify the Department of Revenue of any ohanges in the information prided.
Signature .
Date
FOR OFFICE US^jZfNLY
V
MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
East 83rd Street
Location, etc:
No. 1136 A
(Permit No. 71018)
Distance or extent:
Hours:
at all times
Days:
no exceptions
WAYNE GILES
MICHELLE A. HARRIS Alderman, 8th Ward