City of Chicago Richard M. Daisy, Mayor
Department of Revenue
Bea Reyna- Hickey Director
City Hall, Room 107 121 North LaSalle Street Chicago, Illinois 60602 (312)747-4747 (TRIS) (312)744-0471 (FAX) (312) 744-29 75 (TTY)
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DISABLED PERMIT PARKING
REMOVAL APPLICATION
HANDICAP FOR SIG PERMIT NUMBER:
MOVAL REGARDING PROHIBITED PARKING EXCEPT FOR
(PLEASE PRINT Or TYPE)
NAME OF HANDICAPPED INDIVIDUAL: ^fefl pJ \< \r\. Si ^\Q\ i I ill_
REMOVAL LOCATION OF HANDICAP PARKING SPACE REQUESTED:
(PLEASE PRINT Or TYPE CURRENT SIGN LOCATION ADDRESS) ~ CHICAGO, ILLINOIS (ZIP CODE)G^(o^3 (PHONENUMBER)7^ff-7?0-033V
REASON FOR REMOVAL-TJ" \X\0 \)£d_
ILLfNOIS VEHICLE LICENSE NUMBER:
( W Or V PLATES)
ILLINOIS DISABLED PLACARD NUMBER: A 6r ( o "I D (p \
(SECRETARY OF STATE DISABLED PLACARD)
CERTIFICATION: T. KNOWLEDGE
: THE ABC
ABOVE INFORMATION IS CORRECT TO THE BEST OF MY LJREC
' (SIGNATURE OF APPLICANT)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT WRITE BELOW THIS LINE ALDERMANIC CERTIFICATION:
( Aldermanic Signature)
(WarS) (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
8£99826SZZ
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