Mar 08 2011 4:19PM HP LASERJET FAX
773-523-8440
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City of Cbietjo
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2nd Floor
CHicato. IHinoU 60405 (Mil Mi-:^?
1 HANDICAPPED PERMIT PARKING
' s*, . (LA RF.MOVAL APPLICATION
I FOR SECN REMOVAL REGARDINC PROHIBITED PARKING EXCEPT FOR HANDICAP PEWIT NLM3ER; °[ ^1
I (Please pri^c or cype.)
NAME OF HANDICAPPED INDIVIDUAL
REMOVAL LOCATION OF HANDICAP PARKING SPACE REQUESTED:
^ ... .
Please princ or cvpe current feie
(Please princ or cype current feign location address.) CHICAGO. ILLINOIS (ZIP CODE) (jpQCr.S^ (PHONE NUMBER)
NAME A2iD 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 HANDICAPPED PLACARD NUMBER:
(Secretary of Stat Hartdicap Placard)
CERTIFICATION: THE ABOVE INFORMATION IS CORRECT TO THE BEST OF MY KNOWLEDCE:
ignzcure of applicant) * Jlfrjvl CJ ^^^f.
(Signzcure or ap FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN APPLICANT: DO NOT WHITE BELOW THIS LINE.
ALDERMAN IC CERTIFICATION:
(Aider^artic S lgr.a :ur » )
(Ward)
(Dace)
I AFTER APPROVAL. THIS APPLICATION IS TO BE FC-WARDED TO COUNCIL. SERVICES. THE .ALDERMAN. AT THE TIME THE HANDICAP SIGN REMOVAL ORDINANCE IS I STRODE: