4*
05/1.A/2010 TUE 10:39 FAX
3001/001
City of Chicago Richard M. Daley, Mayor
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)
BUILDING CH1C/1COTOCSTHEB
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER
(Please print or type)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED
(Please print or type current sign location address) CHICAGO, ILLINOIS (ZIP CODE) ^>%^1pH0NE NUMBER) 773 cVV^ c/2 O) REASON FOR REMOVAL: ^\.Q\JJL- c CL<^J*
ILLINOIS VEHICLE LICENSE NUMBER:
ILLINOIS DISABLED PLACARD NUMBER:
(Secretary of Slate Disable Placard) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF BY KNOWLEDGE:
iature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WRITE BELOW THIS LINE
ALDERMANIC CERTIFICATION
(Aldennanic Signature)
(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