MEMORANDUM FOR TRAFFIC REGULATIONS
OVERRIDE
PROHIBITION AGAINST PARKING (Except for the Handicapped):
Street, etc:
West 73rd Street
Location, etc:
No. 3525
(Permit No. 65653)
Distance or extent:
Hours:
at all times
Days:
no exceptions
ADELA GAMEZ
xONALANE Alderman, 18th Ward
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
65653
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 note1 The application tee shall be waived tor 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).
2 State Identification Number
o"0T na-T .rTb IS&MoTowfrWjWVp.
1. Date of Birth
MO ^_ DAY
3. Drivers License Number
4. Applicant Last Name
\6\(x\(f\\e\7\
Ml
First Name
5. Home Address (primary residence)
_ STREET NUMBER | DIR. STREET NAME , - I
3i5>iri li/.l7i3iTh/i ifliTirieiafi
| ZIP CODE
6. Address where signs will be posted
DIR. I STREET NAME
STREET NUMBRR. I DIR. I STREET NAME . m_ .
3 If I >l TI W.l 713 W fafJ Ifil'f ir \& £ \f\ I I
, WARD NUMBER
7. Phone Numbers
Home
7i?i1tVi7i/tVi3
i. Current Permanent C
8. Current Permanent Disabled Placard Number
2\0
Business
J_L
. Registered to
Ao/Ja Game?-
Relationship to Applicant
9. Current License Plate Number
. Registered to
City Sticker No.
Relationship to Applicant
10 Description ot Medical Condition and Disability
Alternative Parking: Please note your application may be denied if you have alternative accessible oft-street parking options.
11. Is there ott-street parking available at your primary residence (I.e garage, car port, driveway, elc,)?_
□ no
12 If yokr answered Yes to question 11, please describe:
QKGarage: □ Driveway; □ Car Port; □ Other:
13. Is your olf-street parting accessible? ~ x / / ~~Z QfWSW Vcifl
□ Yes; atfsic, Please explain: 1$ tty* W in .
14. Aflirmation: I hereby affirm that the above inlormation is true and correct. H the City of Chicago Deparimeni of Revenue datermines that lhe applicant has falsely represented one or more of the above conditions, the applicant shall be subject to a line ol nol less than 5100 but no more than $500, and the application shall be denied. I also understand thai II Is my responsibility to notify the Department ol Revenue ol any changes in the inlormation provided.
Signatun
Date.
FOR OFFICE USE\ O^MLY
/IS S?.________ \JI
City of Chicago Richard M. Daley, Mayor
Department of Rmmtc
Bea ReyiH-Hickey Oi rector
City Hull. Rooml07A 121 North LaSollc Street Chicago. Illinois S0602-1288 (3.12) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-297J (TTY)
December 3, 2010
ALDERMAN LONA LANE WARD 18 8146 S KEDZIE CHICAGO, IL 60652
Dear ALDERMAN LANE:
The Department of Revenue has received a request for disabled parking signs. The Department initially did not recommend installation of signs. However, the applicant successfully appealed to the Mayor's Office for People with Disabilities (MOPD).
Provided is the name and address of the applicant, the exact location proposed for the signs, and the permit number assigned.
Applicant's Name: ADELA GAMEZ
Applicant's Address: 3525 W 73RD STREET
Address/Location of Signs: 3525 W 73RD STREET
Permit Number: 65653
Work Order Number: H10-1388
Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Anthcmy Gambino Manager of Parking
NElGI|ORH^jDS