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PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
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An application will not be considered 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 PO. 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).
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4. Applicant Last Name k\9\m i i i i i i i i i i i i Ml T First Name ViORiMiei iiii
5. Home Address (primary STREET NUMBER DIR. 'il°(lilcl! 5 residence) STREET NAME II &p CODE KJolul/ I I I I I I I I I I I I I IIColOlC,
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8. Current ...
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