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City of Chicago Richard M. Daley, Mayor
Department of Revenue
Bea Reyna-Hickey Director
City Hall. Room 107 121 North LaSalle Strict Chicago, Illinois 60602 (312)747-474? (IRIS) (312) 744-0471 (FAX) (312) 744-2975 (TTY)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER [50 7_
(Please print or type)
NAME OF DISABLED INDIVIDUAL:
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
(Please print or type current sign location address.)
CHICAGO, ILLINOIS {ZIP CODE)_(PHONE NUMBER)_
REASON FOR
REMOVAL:
ILLINOIS VEHICLE LICENSE NUMBER:
(W or V plates)
ILLINOIS DISABLED PLACARD NUMBER:
(Secretary of State Disabled Placard) CERTIFICATION: THE ABOVE INFORMATION^ CORRECT TO TUP * BEST OF MY KNOWLEDGE:
5 INFORMATIONJS CORRECT TO THE 1
(Signature of Applicant) FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: Hf) NOT WRITE BRIM XmS 1 ^ ALDERMANIC CERTIFICATION:
(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.