Mar 03 2011 8:52PM Feb 17 2011 6:09PM
HP LASERJET FAX HP LASERJET FAX
773-523-8440 773-523-8440
P- 1 P-3
£PPLtCATJ0N FOR DISABLED PARKING SIGNS 7740 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless: V" ~^4"^
Alt lines of the application have been completed in full;
• A check or money order for 370.QO made payable to the City of Chicago resubmitted] as payment ot the application fee; Please note: The application tee shall be waived for any person fralding a valid, current disabled veterans plate
• Disability must be permanent as evidenced fay a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
Proof of residency, in the form of a oopy of your drivers license, state identification, or utility bills are submitted at the time of application.
Compteted application forms may be returned tc; the office of your alderman, any City of Chicago Department of Revenue facilty, o; via mail at P.O. Box 1303100, Chicago. «. SD680-3100, ATTN. Disabled Permitting Section. A $25.00 maintenance fee wiH be bSled to you annually. Should you have questions or concerns, please call our permit processing division al 312-744-PARK{727S).
1- rJateofeirth I 2, State tcfentification Numb«r NO _ OAV _ y£A« O-l i I \ la I jy\ I H*lD i KilSKMfelriai K 3. Drivers License iMumber k\) ioloTo ! \\a \sT'A \ l\ i la
4. Applicant Last Name Rlulfcl HOJ I I ! I I ! I I I I I Ml First Name riimi/liiOiONM i I I i i
S. Home Address (primary srneeTNUMBEH | dip. am )L5i w residence) STHECT HAkne 1 SP CODE 3181 lPiU/JlcUl 1 1 1 i 1 1 ! 1 ! 1 Ul*|fck3fl
6. Address where signs will be posted &rP€STN«;MBER an. street w»we
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