Gtv of Chicago Richard M. Daley, Mayor
Department of Revenue
Hugh P. Murphy Director
Ctlr Hall. Room 107 121 North LaSalle Street Chicago. Illinois 60602 (Jl2*744-6146 (.»I2)74-M)47I (FAX) (Jlil7440«75 (TTVJ
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DISABLED PERMIT PARKING
REMOVAL. APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER
(Please print or type.) NAME OF DISABLED INDIVIDUAL: £lv. A Sa1<,/^Jo
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
2CZ£> £■ /"/o rVi A frl__
( Please print or type current sign locatioo address.) (-y-jf)
CHICAGO, ILLINOIS (ZIP CODE) 4ofj2 g rpHONF. wtiMBERt Stt-t-ovo REASON FOR REMOVAL: JWOV^J 4o 2731 Lo- J NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE:
(Please provide information only iT billing information differs.) ILLINOIS VEHICLE LICENSE NUMBER;_
ILLINOIS DISABLED PLACARD NUMBER.
(W or V plates)
(Secretary of State Disabled Placard) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE
(Signature oFApp
^Ll-
(Signature oFApplicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE__
ALDERMANIC CERTIFICATION:
(AJdermanic Stgnalj
(Ward)
(Date)
AFTER APPROVAL. THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES. BY THE ALDERMAN. AT THE TIME THE DISABLED SION REMOVAL ORDINANCE IS INTRODUCED.
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