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312 768 5823
JUN 11 2007 11:17 FR COPY ROOM 312 768 5823 TO 917733488480 P.01^02
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DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER_
( Please print or type. )
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED: ( Please print or type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE).
_(PHONE NIJMB£R)_
REASON FOR REMOVAL: Vl/fftJV^ (kAASl^ [hhnduoJ
ILLINOIS VEHICLE LICENSE NUMBER:
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ILLINOIS DISABLED PLACARD NUMBER:
( Secretary of State Disabled Placard ) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:
( Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LLNE, ALD^MANlcTERTrFTcATIoff
(Aldermaiuc Signature ) ( Ward ) ( Data >
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED