APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
73481
An application will not be considered complete unless: All lines of the application have been completed in full;'
• A check or money order for S70.00 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 holding a valid, current disabled veterans plate.
• Disability must be permanent as evidenced by a copy of your valid disabled 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.
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 ___ YEAR O | O ; i ! '/ I C I 7 2. State Identification Number 3. Drivers License Number S Yh 12 | o~3 12 \o kid7\o \S\'i
4. Applicant Last Name | Ml | S IA | 01 i | r | u | | | | | | | | | | | First Name I ri | A IJ I fi I U I S I H | | | |
5. Home Address (pri STREET NUMBER c 14 I 5 It- I mary residence) UIH. STREET NAME II ZIP CODE V C\L- 1A | £ | £\tf | o\v |T| 1 *|2. |C |f/ \i \C\A U-k Ik 14|S
6. Address where sig STREET NUMBER C\A \s \(- I ns will be posted ...
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