DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER ¥.r Ji 4
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: Aa.^A X J*Mt.* ^_
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
1H0H ficnnstf-
(Please print or type current sign location address,)
CHICAGO, ILLINOIS (ZIP CODE) bo6v
REASON FOR RKMOVAL: ^ g, a +, S+, J__
NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE: 7 S.A -a^A,
(Please provide information only if billing information differs.)
ILLINOIS VEHICLE T .TCENSE NUMBER: &S*T ^ 3 ^
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER f 4 /296&_
(Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE: An-A+Jl. A/Zu***^.___
(Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT'. DO NOT WRITE BELOW THIS LINE
SekScSScation: y^^/frfj^
(Aldermanic Signature)
(Ward) (Date)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED.
DECEDENTS LEGAL NAME. !?* V; £.#;V "• "'¦
vROSIE BRADD'K'^A: ai':^ \i y:]>:
FEMALE
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JUNE 22;20i0 IH»V<
j COUNTY OF DEATH^iy^^^SW'^P^'^'
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HOSPITAL OR OTHER INSTITUTION NAMEf S
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'SOCIAL SECURITY NUMBER 337-20-4920 ''' ¦'' "
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