Ilry of Chicago lichardM. Daley, Mayor
Icparlment of Revenue
leaKflyna-Hickey lireclor
:ity Hull, Room 107 21 North LaSalle Street licngo, Illinois 60602 317) 747-47'l7 (IRIS) 312) 744-0471 (FAX) 312) 714-297srrrY)
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DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARD TNG PROHIBITED PARKING EXCEPT FOR DISABLED PERMJT NUMBER^
( Please pruit or type. ■'
NAME OF DISABLED rNDrVlDUAL:___^__________
.REMOVAL. LOCATION OF DISABLED PAMONG SPACE REQUESTED:
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{ Please print Or type current, sign locatioa address. )
(PRUNE NUT _ ER)_
CHICAGO, ILLINOIS (ZIP CODE)(^> REASON FOR REMOVAlNl_ d^^^jd^
V
ILLINOIS VEHICLE LICENSE NUMBER:
( W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
( Secretaxy of State Disabled Placard) CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE
BEST OF MY KNOWLEDGE:_________
( Signature ot" Applicnnt)
FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
AP rf}-c?T ■A^___£_^QW THIS ^SNEl
( 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
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