City of Chicago Richard M. Daley, Mayor
Department of Revenue
Hugh P. Murphy Director
City HjII. Room 107 121 North LaSalle Street Chicago. Illinois 60602 (312)744-6146 (312) 744-0471 (FAX) (312)744-2975 (TTY)
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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: J?) Pt/fryfx* CbT J^O
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
_Z&Z3 s. /Z0//H_
( Please print or type current sign location address. ) (J~j/J CHICAGO, ILLINOIS (ZD? CODE). .(PHONE NUMBER). 376- WS?-
REASON FOR REMOVAL:
NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE:_;_'
(Please provide information only if billing information differs.) ILLINOIS VEHICLE LICENSE NUMBER:_
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER
(Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE: X/^^^/i^^^^^^^
' (S'ignaturc^f Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
{/ (AJdermamc Signature)
(Ward)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES . BY THE ALDERMAN. AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED.