#r|0A^QN FQR Dl|»B^ PARKING SIGNS
¦fciEAfiliEpi^ ?^^=
fieation will not be considered coitiplete unless: I lines rf;tte.appU^ in full;
A check ormpney^ to the City of Chicago is.submilted as payment of the application;feje;|1010|A
Please notg?Theiappli^or|;{ee disabled veterans; olate-1;
Disability'Wu^^i^j^im^^nt^^-evidenoed by a copy of your valid disabled placard and/or current vehicle registration :: |^J submitted at^ x ^'Sa
Proof d^i^^:M4h^'fomt'^f a copy of your drivers license, state identification, or utility bills are submitted at the -*v|l time of application. '•*'•¦
Completed application forms may be returned to:,the office.of your alderman, any City of Chicago Oerjartment of;Revenue;0|||J facflftyiiorvi^ mailatfcO;.;Bb^ Disabled. Perrninjng,.Sea)bn? '«$25;00;^^rj|(wfe^^)
fee wll^feeibilledjto you annually. Should you have questions br concerns, please can bu"r penirtit pfoinssing.olvTsiolt^^i^^^n 744-PARK (7275).
mm
to ¦ ,"
ft
1... Dateof:Birth
f*6L-r- OAY_
.VEAB
2. State Identification .Number
3. Drivers License Number
Mll'First Name
5. Home Address (primary residence)
STREET NUMSER' OWt | OTEBT. MMie
6. Address where signs win be posted
STREET NUM&EH OOtT STBEET.'r"- v
7. "Phone Nurtibers
Home
if,. 1 a^isH?-
8. Cun^nt PemiahCTt 0i3ab(e
9. Current License Plate Number
Business
Registered to
tfcQesjcrlpt^ Disability "Alternative Parking:please note ybur.applicatibh
Alternative Parkir^-. Please^ r»ve;alierr)aWe:a^^ ott-'stfeet parking options.
11. Is there off^treet r^rkirtg ayapbie a (i.e qa/affl. car port drwW^efe)?
l2.j1you answered Yes to question 11 \ please describe: JsjtGarage; ? Orrveway; ? Car Port- ? .Other
13.1s your off-street parking accessible?
O Yes; ^ No. Ptease explain: &\XJoVflffifj^ flOgSffto**-
14. Affirmation: I hereby affirm that the above information is true ami correct, (f the City of Chicago Department of Revenue determines
£1, trrat Jrm ^r^lcart has falsely represented one or more o...
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