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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). ' /\ . '." '}
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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)
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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 |
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City Sticker No bom 59 |
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10 Ocscription ot Medical Condition arid Disability . ^ , -% ;
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■ Alternative Parking: Please note your application may be denied i' you have alternative accessible off-street parking options. ■| IV;is there off-street parting available at your primary residence Q YES JSfNO
I (i.e garage, car port, dnveway, etc.)? .___ _.____
! 12,1! you answered Yes to question 11, pteassdescribe: ') j Garage: '3 Driveway: Zi Cor Port: 3 Other:
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your off-sireel parking accessible? 'JYes: □ No. Please explain;
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14. Affirmation: i hereby affirm that the above inforrriaticn is true end correct. If the City of Chisago Oeparunent'o! Revenue dstermlfies '! r « [.:, that the applicant rt3s falsely represented one or more of the al^e-conditions, ihe applicant $ha|i be subject ip a (in© of nqt teiss Jh^n ; ,;
$100 buLno rrtore than SSOO. and the appttrialion shall be denied. <j also understand (hat it Is my respansibitjiy- to ^notify toe %pjtnfe.rf!ipf;f ^ h-f[
Revenue^ of any changes in tne Information provided. : ' ■■i n
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FOB OFFICE USE ONLY
City of Chicago Richard M. Daley, Mayor
January 4, 2011
Department of Revenue
Bea Reyna-Hickey Director
City Hall, Room 107A 121 North LaSalle Street Chicago, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
GEORGE MUHAMMAD 6748 S HONORE ST CHICAGO, IL 60636
Dear Applicant:
The Department of Revenue has recommended installation of disabled parking signs near your residence. Based on this recommendation, the signs for your restricted parking space will be installed. However, your application must be approved by City Council. If the proposed ordinance is not passed within four months after its introduction, the permit shall be revoked and the restricted parking signs removed.
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The parking permit must be renewed annually. The fee is $25.00. A renewal notice will be mailed one year from the date the signs are installed.
Please be advised that you are required to report any changes to the information provided on your original application to the City of Chicago Department of Revenue. You are also required by City law to notify the Department if you no longer meet the following permit qualifications:
* You must hold either a valid, current disabled veteran's state registration plate or permanent person with disability license plate, permanent parking placard or device authorized by the Illinois Vehicle Code;
* Any vehicle parked by you or for you in the designated area must bear the disabled license plate, permanent disabled parking placard or devices issued to you by the State of Illinois;
* You must continue to reside at the home address listed on the original application.
A residential disabled parking permit will be issued to you by the City of Chicago. It must be placed on the right side of the dashboard. Only qualified vehicles displaying the permit are authorized to park in your restricted parking space. The permit number must be visible from outside your vehicle. The permit will be installed at:
Address/Location of Signs: 6748 S HONORE ST Permit number: 76624
Should you have any questions or require additional information, please contact the City of Chicago's Helpline at 312.742.7434.
Very truly yoQrs,
8
Kntno^ ' Gambino Manager of Parking
Copy: ALDERMAN FOULKES
January 4, 2011
ALDERMAN TONI FOULKES WARD 15
3045 W 63RD STREET CHICAGO, IL 60629
Dear ALDERMAN FOULKES:
The Department of Revenue recommends installation of disabled parking signs as described below. The application has been reviewed and a survey of the location has been conducted. Since the applicant has met the requirements outlined in the Municipal Code, the signs will be installed.
Provided is the name and address of the applicant, the exact location proposed for the signs, and the permit number assigned. Please introduce an ordinance to post residential disabled parking signs at the location recommended, if one has; not yet been introduced.
Applicant's Name: GEORGE MUHAMMAD
Applicant's Address: 6748 S HONORE ST
Address/Location of Signs: 6748 S HONORE ST
Permit Number: 76624
Work Order Number: H10-1491
If the proposed ordinance is not passed within four months after its introduction, the permit shall be revoked and the restricted parking signs removed. Should you have any questions or require additional information, please contact our office at 312.742.7434.
Very truly yours,
Manager of Parking
Enclosure: Disabled Signs Application