City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER / lo I
(Please print or type.)
NAME OF DISABLED INDIVIDUAL: MolX I Vvt <
rVo-do
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE>^/39 (PHONE NUMBEr/773) kf5~- 3U13 ______________________ , a_
ILLINOIS VEHICLE LICENSE NUMBER:
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
( Secretary of State Disabled Placard) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:
( Signature of.Appficant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION:
7
(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