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77274
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY
BEFORE COMPLETING THE FORM ry\J ^0 Qjfr
An application will not be considered complete unless: tftA ^iJigJ? i '
All lines of the application have been completed in full; \J\1\CMS}-*<K~ pr\**~\j .
A check or money order for S70.00 made payable to the City of Chicago is submitted as payment of the 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-PAFK (7275).
t. Date of Birth
MO _ UAY
VEAH
on io i2> 11 \h
2. State Identification Number
z\i\o\m\on inTnimv
3. Drivers License Number
VI£121012 1* 10 I7lw 1 71« 1^
4. Applicant Last Name
Viaisiqiftie.i?,
Irh
Ml
First Name
mrii'isieidhai
5. Home Address (primary residence)
STREET NUMBER DW. STREET NAME
31315 131 mifclvlfcirlQirlftieifl
fi Adrirojta where skins will bs nnsled
ZIP CODE
6. Address where signs will be posted
STREET NUMBER Om. STREET NAME
:*>I3I5I3 1 Mlflulfelcklrlftlftlrt
7. Phone Numbers unm*
J_L
WARD NUMBER
Home
Business
I i2.
8. Current Permanent Disabled Placard Number |
Registered to |
Relationship to Applicant |
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9. Current License Plate Number QJi<z <ks\ |
Registered to |
City Sticker No. SI 2 £ |
Relationship to Applicant |
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10. Description of Medical Condition and Disability f\ I si I I
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
□ YES j^NO
11. Is there off-street parking available at your primary residence (i.e., garage, car port, driveway, etc.)? _
12. If you answered Yes to question 11, please describe:
□ Garage; □ Ortveway; □ Car Port: □ Other:
13.1s your off-street parking accessible? □ Yes; □ No. Please explain:
14. Affirmation: I hereby affirm thai 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 fins ot 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 ot Revenue of any changes in the information provided.
Signature
Date
III 22/anil
FOR OFFICE USE ONLY
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Jan 26 2011 5:57PM
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Chicago Public Schools Principal Dr. Rusty Bumette Report of Student Progress
Jacqueline 8 Vaughn Occupational High 2010-2011 School Year
ff^?0', ,, . ' Quarter 1 Progress Report
4335 N. Linder Ave,
Chicago, IL 60641
Vasquez. Delilah c/o Ms. Grisella Vasquez 3353 W EVERGREEN AVE Chicago, IL 60651
09/13/2010
' ~\
This is a report on how Delilah Vasquez is doing in his/her classes for the Quarter 1 Progress Report. There is still time to make improvements in his/her grades. The success of your child is a cooperative effort. If you have any questions or concerns, please call the school at 773-534-3600 and tell the office staff that your child is in Homeroom N/A and they will connect you to his/her counselor.
Sincerely.
Dr. Rusty Bumette
Principal
ID#: 37097462 Homeroom. N/A
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WORLD LITERATURE-11142 |
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UNITED STATES HISTORY-2SG12 |
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It meeting course standards |
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40042 |
INTEG MATH PROG IV-400«2 |
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Computer Information TecltnoJoay |
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Outsiandjno/Hiariry motivated |
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ART 111-31S32 |
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A |
Is wen organized and prepared |
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Days Absent:
2
Jan 26 2011 5:57PM
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'-■ PPOUDlVSf-nvlNG
Ivehfy rri-AUTiffNiiciivo; rt«su fi-tonc sra.mwryimwwr
<C0S WEST NO FTTH AVE. - CHICAGO, LUKCX3 50039 PHONE: (773j 772*100
CH::SK IWCKGP.r-Uft!.' Affl-'A Ci IANCES r.8i flf! flRADUALlY FROM TPP TO 60TTGM.!
No. 02458
11/22/201D
REPUBLIC SANK OAK BROOK. ILLINOIS
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7733950146
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I l I I I I I I l I I I
160528075
Healthcare Programs for Families
ftBd&S
Case ID Number
9*
237
22
BX9180
Elinrbility Period
ii-oi-io Through n-3°-
10
CASELOAD: 923
VASQUEZ, CAI SELLA .353 W EVERGREEN AVE CHICAS0, IL 60651-2308
No copays for children under age 19 or pregnant women. No copays for generic prescriptions, lab, radiology, emergency or family planning services. Adult copays ere $2 for certain types of medical visits, up to S3 per day for certain types of Inpatient hospital stays and $3 for brand name prescriptions.
HFS 46--C »-4-t>«) J>-II0II» 4,478-0234
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|l 1-01-70 BigjtHUtyJ»ariod 11-3Q-1Q | £
Ctt0 ID94 237 22
Number:_
BX9
ASQUE-, CRISELLA '-
353 W EVERGREEN AVE CHICAGO. It_
ONLY THE FOLLOWING PERSONS ARE ELIGIBLE
I
QRI SELLA VASQUEZ
MEDICAL DELILAH VASQUEZ
MEDICAL **********-******-**^
TOTAL NUMBER OF ELIGIBLE PERSONS: 2
ID/: 080671365. DOB:07-03-7* ID#:1800834. 5 008:02-24-92
ALL KIDS ASSIST/FAMILYCAR E ASSIST/MOMS * BABIES
OOT 10*32
-Please see front of card for important information-
rat*
Thursday, January 21, 2011
To Whom it may concern,
My Name is Rami Suleiman the owner of the property at 3353 W. Evergreen in Chicago, IL. Grisella Vasquez is my tenant at the building. I would like to request a handicap spot in front of my building for my tenant's daughter Oelllah Vasquez. Grisella does not have a garage access in the building to park, her vehicle, it is important for her have a parking spot in front of the building. If you have any questions you can contact me at my cell 708-997-4252.
City of Chicago Richard M. Daley, Mayor
December 16, 2010
Department of Revenne
Bcs Reyna-Hiekey Direcior
DELILAH G VASQUEZ 3353 W EVERGREEN CHICAGO, IL 60651
City Hall. Room 107A 121 North LaSalle St rwt
Dear Applicant:
Chicago, Illinois 60602-1288
(312) 747-4747 (IRK) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
The Department of Revenue received your request for disabled parking signs. The application was reviewed and a survey of the location was conducted. The Department cannot recommend the application.
The Department's reason for not recommending the application is:
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 us at (312) 742-7434.
Very truly yours,
AntKbny Gambino Manager of Parking