02/09/2011 WED 9:00
FAX
0001/001
City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyra-Hickey Director
City Hall, Room 107 A 121 North LaSalle Street Chicago, Illinois 60602-1288 (312) 747-4747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER *S^?/5>3
(Please print or type)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OJ DISABLED PARKING SPACE REQUESTED
/
(Please print or type current sign location address) CHICAGO, ILLINOIS (ZIP CODE) (p^&D (PHONE NUMBER)*"^ -£^3
REASON FOR REMOVAL: 0f\O\P cl_
ILLINOIS VEHICLE LICENSE NUMBER:
ILLINOIS DISABLED PLACARD NUMBER:
(Secretary of State Disable Placard)
CERTIFICATION: THE ABOVE INFORMATION,^ CORRECT TO THE BEST OF BY KNOWLEDGE: ( A
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WRITE BELOW THIS LINE
lldermanic Signature)
9 <*)-!(
(Ward)
(Date)
AFTER APPROVAL, THIS APPLICATION IS TO BE FORWARDED TO COUNCIL SERVICES, BY THE ALDERMAN, AT THE TIME THE DISABLED SIGN REMOVAL ORDINANCE IS INTRODUCED