490-002 12/27/U5
74577
APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
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 holdjog-a-valid,current disabled veterans plate.
• Disability must be permanent as evidenced by a copy of your validmisabled 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. V.--~^C< SCUca- & «""™ Aih)*e±r
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. 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).
1. Date of Birth
MO _ DAY
t° I o I V I /
1 \6l
2. State Identification Number
3. Drivers License Number
>!4. Applicant Last Name
2r\o\ u\^\A^j\ A
5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME
Ml
Rrst Name
STREET NUMBER
S\S\ 1 I z~
\rl\ \L\U\J\*
| ZIP CODE
6. Address where signs will be posted
STREET NUMBER DIR. STREET NAME
r |g 11 I *4
L \ ^\ tf\ &WARD NUMBER
7. Phone Numbers
Home
7 I 7 I 3 1 1 5 I 31 £ I /
3-1 X
Business
8. Current Permanent Disabled Placard Number
HI
D
Registered to
Relationship to Applicant
9. Current License Plate Number
UJ
Registered to
City Sticker No.
Relationship to Applicant 5°*7
10. Description of Medical Condition and Disability
Alternative Parking: Please note your application may be deni...
Click here for full text