City of Chicago Richard M. Dalej, Mayor
Department of ReTeoue
Bea Reyua-Hickey (Director
City Hail7 Room 107 ! 21 North LaSalk Street Chicago, Illinois 60602 (312) 747-1747 (IRIS) (312) 744-0471 (FAX) (312) 744-2975 CITY)
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING EXCEPT FOR DISABLED PERMIT NUMBER -
NAME OF DISABLED INDIVIDUAL:
( Please print or type.)
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REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED: ^3
' Please print or type current sigi
(Please pruit 6r type current sign location address.)
CHICAGO, ILLINOIS (ZIP CODE) £)0^2> %>HONE NUMBER) REASON FOR REMOVAL: ./WOV^
ILLINOIS VEHICLE LICENSE NUMBER:
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
( Secretary of State Disabled Placard j
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:
an Ca-
( Signature of Applicant)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: DO NOT ^_EjELQW THIS LINE ALDEBMAMC CERTIFICATION:
(AracrruanicSigGature)
(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