City of Chicago Richard M. Daley. Mayor
Department of Revenue
Hush P. Murphy Director
City Hall. Room 107 121 North LaSalle Street Chicago. Illinois 60602 1312)744-6146 (3121 744-0471 (FAX) (3121 744-2975 (TTY)
htip:.'/uuM.L-i.i.'hi.il.us
DISABLED PERMIT PARKING
REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER
( Please print or type.)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
■ ( Please prinTor type current sign location Address.) CfflCAGO, ILLINOIS (ZIP CODE). (PHONE NUMBER).
REASON FOR REMOVAL:,
NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE: _
(Please provide information only if billing information differs.)
ILLINOIS VEHICLE LICENSE NUMBER:_
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER-
(Secretary of State Disabled Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDGE:_
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE
alpt^manTcer^^
(Aldermanic Signature)
6^
(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.