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7734343689 * 2/
T-81S p.002/002 F-401
Gty of Chicago Richard M. Daley, Mayor
Department »f Jtcvmoe
DcaXgriM-Hickey Director
CityHaJl.Room 107A 121 North liSallt Street Chicago, Ulinoii (0602-1288 (312) 747U747 (I RJS) f312) 744-647! ffAX) (312) 744-2975 (Try)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER If 3.3 y <7_
(Please print or type)
NAME OF DISABLED INDIVIDUAL: r> \ n V.^% ft o.U
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED
(Please print or type current sign location address)
CHICAGO,ILLINOIS (ZIP CODE) (.Of. 36 (PHONENUMBER) (7 7 3) 73 7- 92XO
REASON FOR REMOVAL: X moujuX n^9>x UL». s Ir*. I
ILLINOIS VEHICLE LICENSE NUMBER: 3 O f S "3 7___
ILLINOIS DISABLED PLACARD NUMBER: fiF 9 1*1 $8_
(Secretary of $ wee Disable Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF BY KNOWLEDGE:
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WRTTE BELOW THIS LJQME
ALDERMANIC CERTIFICATION
AFTER APPROVAL THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED