APPLICATION FOR DISABLED PARKING SIGNS 77393 PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
•>r\ application wiil not be considered complete unless: . _ _
• All lines of the application have been completed in full; "if c> 10|• A check or money order for $70.00 made payable to the City of Chicago is submitted as payment of the application fee; Please note: The application tee shall be waived for any person holding a valid, current disabled veterans plate.
• Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application;
• Proof of residency, in the form ot a copy of your drivers license, state identification, or utility bills are submitted at the time of application,
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100, Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth MO DAY _ YEAR o 1 I .o \ 3 M 1 C 2. State Identification Number I-1 i T.I I i T l u 3. Drivers License Number ^ivi^t^i i\c\i-a\s\s
4. Applicant Last Name 1 Ml | First Name S|A|L|£>| 4|D|o: , 1 1 M^H^I*!*! 1 1 1 1 1 I
5. Home Address (pri STREET NUMBER I2H7I3I3 mar> dir. u). ' residence) STREET NAME iRp| |S|T[ |4_[S|T| \f\l_\°\o\
6. Address where sig STREET NUMBER 13-1713 13 ns w CXR OJ. II be posted STREET NAME ^3!^|i>i \s\r\ i . WARD NUMBER 1 1 1 1 1 I 1 I 1 1 I I M \*
7. Phone Numbers Home 7 17 1 ^Ts 12-13 7^ I o 0 | o Business 1 1 T 1 1 T i ; 1
8. Current Permanent Disabled Placar...
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