APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY gEFORE COMPLETING THE FORM
77395
An application will not reconsidered complete unless:
• All lines of 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 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-PARK (7275).
1. Date of Birth
MO _ DAY
o n \3 i) i oi4
2. State Identification Number
3. Drivers License Number
4. Applicant Last Name
Ml
First Name
Ols Iv tell \c\\o
5. Home Address (primary residence)
STREET NUMBER
I IB 1515 |
STREET NAME
lH.
ZIP CODE
6. Address where signs will be posted
STREET NUMBER urn. a I net I injmivie .
*3I5I iu;., 4^Hk I Pi I
STREET NAME
. WARD NUMBER
7. Phone Numbers
Home
m n is i/ ft \2
S \9
Business
8. Current Permanent Disabled Placard Number
Registered to
c
Relationship to Applicant
-SoAf ¦
9. Current License Plate Number
1 7(o?%U7 Mft
Registered to
9*
City Sticker No.
Relationship to Applicant
10. Description of Medical Condition and Disability
Alternative Parking: Please note your application may be denied if you have alternative accessible off-street parking options.
?'YES ? NO
11.1s there off-street pa...
Click here for full text