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City of Chicago Ricbaid M Daley, Mayor
Department of Revenue
Bca Reyna-Hickey Director
City Han, Boom 107 121 North LaSalle Swe: Chicago, Illinois «9S02 (312) 747-4747 (IRIS) (312)744-047! (FAX) [312) 744-2575 (TTY)
DISABLED PERMIT PARKING
REMOVAL APPLICATION
HANDICAP FOR SIGNREMOYAL REGARDING PROHIBITED PARKING EXCEPT FOR
PERMIT NUMBER: W3 Q3_
(PLEASE PRINT Or TYPE)
NAME OF HANDICAPPED INDIVIDUAL: fee r^qcft\Q e Chamber & REMOVAL LOCATION OF HANDICAP PARKING SPACE REQUESTED:
j0405 S. flog
(PLEASE PRINT Or TYPE CURRENT SIGN LOCATION ADDRESS) CHICAGO, ILLINOIS (ZIP CODE) (pCXp^fr gHONE>HJMBERl^~3^S&*-- > 3*7*7 REASON FOR. REMOVAL; g}W>Jg. t S. t^cCeCt&tfcf ( Ot-l^-dOlt\ ILLINOIS VEHICLE LICENSE NUMBER." l4ffll~Z
(W Or V PLATES) ILLINOIS DISABLED PLACARD NUMBER:
(SECRETARY OF STATE DISABLED PLACARD)
TION IS CORRECT TO THE BEST OF MY (SIGNATURE OF APPLIC FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
CERTIFICATION: THE ABQVE KNOWLEDGE:
'PLlCANT)
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
( AlrJermanic Signature) (Van!)
(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
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