^ 02-04-11;12:43PM;
7734343889
APPLICATION FOR DISABLED PARKING SIGNS READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
# ii i
77509
An application will not be considered complete unless: ■ All lines ot 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 tee: 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;
Proofof residency, In the form' of a copy of your drivers license, state identification, or utility bills are submitted ai the time of application.
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department o' Revenue facility, or via mall at P.O. Box 803100, Chicago. IL 60660-3100. ATTN: Disabled Permitting Section. A £25.00 maintenance fee wflt be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (727S).
m
if
i ". >>'-■
1. Date of Birth
MO _ MT _ VCAH
nisi )\z~\ mi
2. State Identification Number
I I I T I I Mill
4. AppllcantLut Name
fllltelJI&l/l Ml....I
3. Drivers Liconse Numbar
oi 6iaiyTVi<?i<?iyT?u a fj
Ml
First Name
X\*i\K\*-\r~\. \0
S. Home Address (pttmary residence)
nWETNUMKR | DM. | STREET MAM E
3l/l/i-7l U. \^\+\H\F\c\
MINIM
IIIP coot
& Address where signs will be posted
mt\in\ U. \4\*h\h\ irUJ
f§ EMinA* Ui ntwfcw Home
7.1 Phone Numbers
717 13 I Wl I 16 1 I / !«/
8. Current Permanent Disabled Placard Number
9. Current License Plate Number
l *Af>0 Nuuocn
in 13 T?i^ i3T/ i5 \' i-/
Registered to
City Sticker No.
/C>£.l-t.kfl£,.
Relationship to Applicant
Relationship to Applicant
lb:Desct1ptjon of Medical Condition and Disability . ^ / MtemelNie Parking: Please note your application may bo denied If you have alternative accessible off-street parWrrj'opiions
«ML-ls there off-street parking available at your pnmaiy residence &YES □ NO (l.a garage, ear port, driveway. ete.)7__
12. If you answered Yes to question 11, please describe: Hreamge: □Driveway: □.Car Pott: □ Other
13.4s- your otJ-etreet parking aoQaaalblaT
Sim
14. Affirmation: I hereby affirm that the above information Ifirue and correct, II 1he*City ot Chicago Department of Revenue determines tfiarine appflcanttiae falsely represented one or more of the above conditions, the applicant snail be sut>|ect to a fine of not less man $100 but no more tnanSSOO. and the application shall be denied, I also understand that it is my responsibility to notify the Dopartmoni of Revenue of any change* In tne Information provided.
Signature
Date.
rn.O. 3>\CC&2-
□ COMPLETE A^Q0^
FOR OFFICE Ui9E_QNLY
PLACARD/PLATE
ESIDENCY
0.2-04-11; 12:43PM;
;7734343889
#6/7
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bca Rcyna-Hiekcy Director
City Hall, Room 107A 121 North LaSalle Street Chicago, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TH)
January 19, 2011
ALDERMAN JOANN THOMPSON WARD 16
5335 S WESTERN AVENUE CHICAGO, IL 60609
Dear ALDERMAN THOMPSON:
The Department of Revenue received a request for disabled parking signs to be posted in your ward. The application has been reviewed and a survey of the location has been conducted. The Department cannot recommend the application.
Provided is the name and address of the applicant, the proposed location of the signs, and the Department's reason for not recommending the application.
Applicant's Name: IGNACIO OREJE Applicant's Address: 2117 W 49TH PLACE
Reason Not-Recommended: ALTERNATIVE ACCESSIBLE PARKING Explanation: GARAGE AT LOCATION
Appeals must be filed within ten (10) days. Appeal requests must be made in writing and state reasons to support a request for a review. Appeals may be directed to the Mayor's Office for People with Disabilities (MOPD), Disabled Parking Signs Appeal. City Hall. Room 104,121 N. LaSalle St., Chicago, IL 60602. A decision regarding an appeal will be made within thirty (30) days of the request. Applicants are notified by mail of the final decision.
Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Anthony Gambino Manager of Parking
cc: Mayor's Office for People with Disabilities