City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Dlinois 60602 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
BUILDING CHICAGO TOGETHER
DISABLED PERMIT PARKING
REMOVAL APPLICATION
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FOR SIGN REMOVAL REGARDING PROHIBITED PARKING-' -HH
EXCEPT FOR DISABLED PERMIT NUMBER -^--^Sfe^:'' ^ '
(Please print or type. )
NAME OF DISABLED INDIVIDUAL: DnO'VA" P , Py^yXn'Q REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
3lX?n M- Yirn^W^ne fh;p.nue_:_:_
((PJease print or type current sign location address.) CHICAGO, ILLINOIS (ZIP CODE) to /)<£><3?(PHONE NUMBER) (_ 3-1/2^ H 1(1. REASON FOR REMOVAL: V-\ j r°/A TP C^^^M O / IX
ILLINOIS VEHICLE LICENSE NUMBER:
(W or V plates)
;.ILLINOIS DISABLED PLACARD NUMBER: fi) D jp (jp °[ % [}
' (' Secretary of State Disabled Placard )
CERTIFICATION: THE ABOVE iisTORMAflON IS CORRECT TO THE
BEST OF MY KNOWLEDGE:
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
(Aldermanic Signature)
3o c?->-//
(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