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APPLICATION FOR DISABLED PARKING SIGNS PLEASE* ir^ft TI^ ! - —
BEFORE GOMPLPriNG 11HE FORM *
An applicatior, will not be considered complete unless: ' Ail lines oi tne application have been completed in full- - ; ! ,•¦'';;
k cneck or money order for 570.00' made-payable lo the City oi Chicago is submitted as payment of Ihe application ?rae: ?iease note: The application fee shall be waived for any person holding a valid, current disabled: veterans 'plats.-.;] Disability must bs permanent as evidenced by a copy of your valid disabled placard and/or current ven'ids!Veg7stira&bn , submitted at the time of application;- j. Proof of residency, in the form of a;copy of your drivars license, stateIdentification; or utility bills are submitted at the time of application. ;.' ¦
Gor.'.plated application forms may be returned lo: the office-of your alderman, any City of Chicago Department of Revenue k facility, or via mai; at P.O. Box 803l00Xhicago( IL 60680-3100. ATTN: Disabled-Permitting,Section.• A^i.C^irnaJntefr^nee"! fee will be billed 10 you annually. Should you have questions or concerns, piease cafhour permit processing division !a-I^ 2-744-PARK (7275). ' /\ . '." '}
Dale oi Birth
2. State identification NurttbGi
3. Drivers License Number
: < Aoplicant Last Kiarne
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Ml FirsLiName *
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\i ; \ 5. Home Address {primary residence)
! i T$S£7 Hiivpgr, iOtP: STREET NAME. _^ Sh ,__•
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W^l 6. Aadress where signs will be posted
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7. Phone Numbers
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8. Current Permanent Disabled Placard Number
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Relationship io Applicant
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'¦¦ 3_ Current License Plate Number City Sticker No bom 59 gslanonship i£yAppfjcaru :j:
10 Ocscription ot Medical Condition arid Disability . ^ , -% •;
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¦ Alternative Parking: Please note your application may be deni...
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