APPLICATION FOR DISABLED PARKING SIGNS 73249 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE -FORM
An application will not be considered complete unless:
All lines ol 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 applicalion fee shall be waived for any parson holding a valid, current disabled veterans piste.
Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration
submitted al the time of.appjtcation;
Proof o! 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 Oepanmenl of Revenue facility, or via mail at P.O. Box 803100. Chicago, IL 60680-3100. ATTN: Disabled Permitting Section, A S25.00 maintenance fee will be billed lo you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Oate of Birth
2. Slide Identification Numbor
3. Drivers License Number
4. Applicant Last Name
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First Name
5. Home Address (primary residence)
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H. Address where sryns v.'ill be posted
STREET NUMClR
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STOEET HAhtC
7. Pnone Numbers
Home
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8. Current Permanom Disabled Placard Number
9. Curren! License Plate Numbor
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Business
Regtstcred to /? , r- //_____
Registered to
City SticKor No.
Relationship to Applicant
Relationship to Applicant
10. Description of Medical Condition and Disability
Alternative Parking: Please hoto your application may be deniod if you have alternative accessible off-stfeet parking options.
11. is there off-street parking available'at your primary residence "S^YES ? NO (i.e., garage, car port, drive...
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