02/18/2811 38:27 7733241585
PAGE 83/
APPLICATION FOR DISABLED PARKING SIGNS 59 ¦, 64
PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application win not he considered complete unless:
• Ail lines o* the application have been completed in full.
A check or money order for S70.00 made payable to the City ot Chicago is subnM:*ci at. r.nvn«*»M t'v aapiurf- ¦ Please note: The application lee shall be waived lorany oerson holding a valid, cir^nt rii*
• Disability must De oernanem as evidenced by a cony erf your valid diMfolec piaCiuo r'i>:.i ¦> ¦<;-•> -;ic- ,{,.,;.,-•• ,i- .-. submittec! at the time ol application;
Proof of residency, in Ihe 'cm ol a copy of your arivers license, slate icientih-^iMn :v mhIi; . utowiifc.: .1 i
time o< application
Completed application lorn-is may be returned to: the oflice of your alderman, any City ot CluAutic i. 'i; .i- :i:-:m .:>- ¦ >(.'¦,¦<.¦: . ,. facility. r>r via mail at P.O. Box 803100. Chicago. IL 60680-3100. ATTN; Disabled Pem-iittinn Section A S2S.00 •n^nnyviro fee will be billed to vou annually. Should you have questions or concerns pieasr can aw pww.f. ¦r-Kwt'yq H.iv.sr¦•: 744-PARK (7275I.
¦ 1 Dale otolith ' 2 State Identification Nijmber I :i. 0".''-. '. i::'r.s!- Ni
WO _ i'A' _ 'I.M. _ _ _
0 i 3 i.....L_L2_i X]£jA.J.rLtf±/j./ lALiM.M.fejj:.J.:^,r.cv , / u /"V.
*. Applicant Last Name T mi "
..... k:<> io Ia/:....:.................j......,....|£
5. Home Address (pnmaSTHFI-1 Sin*fO 1 run | jtiu.[t s,»vl
4?!7i/ IV j S i/?i*ift,f g;/,E. 73:1-' if A . . j £ . ,; (.
Fir?! Maine
6 Address where signs will be posted
ll ill^£^l€l 1 71/ l^uAhm^lIl....I........I. k:. f i-, /
i 7. Phone Numbers Homp ; Business
L.7.iljlZA....A All. .7.1? "J i
j 8 Currenl Permanenl D'Sabted Placard Number 1 Registered if
1 /6(7i~;? '7Z±k$o<-;
'¦.i: : ¦ ,1:
SV Current License PlaiO Numfioi Registered to i Cily S;n:kr.' ...
Click here for full text