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DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER._____
( Pleoic print or type.)
NAME OF DISABLBD INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Pleas* print or type current sign location addrosa.)
CHICAGO. ILLINOIS (ZIP CODB1 bObft (PHONE NUMBER) 7 72'2#-1V j REASON FOR REMOVAL: fX/QT R. (P//0& HGfiLg'
ILLINOIS VEHICLE LICENSE NUMBER: ^ H 5"&£Q_
(WorVpUtw)
ILLINOIS DISABLED PLACARD NUMBER:
(Secretary of St aw Disabled Placard )
CERTIFICATION; THE ABOVE INFORMATION IS CORRECT TO THE
OVETNFOJ
/ (Signet
BEST OF MY KNOWLEDGE_
-r-
ignature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANICXERT^
(Aldemunic Signature)
(Ward)
(Date)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THF. ALDERMAN. AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED
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