APPLICATION pOR DISABLED PARKING SIGNS PLEASE READ THIS FOLLOWIf IG CAREFULLY BEFORE COMPLETING TrIE FORM
77403
An application will not T>e crj^isidered complete unless; i ; nnii_N*_t
• All linfis nf the application have hefin rompleled in fjll. TjJfAjJ' fl- I
• A check or money order lor $70,00 made payable X (he City ol Chi; ;ago is submitted as payment of the application fee: Please note: The application fee shall be waived br any person hoi |mg a valid, current disabled veterans; plate
• Disability must be permanent as evidenced by a copy ol your valid iisabled placard and/wr current vehicle registration submitted al tho timo of application;
• Proof of residency, in the form of a copy of your di vprs license, stat j identification, or utility bills are submitted at Ihe time of application
Completed application forms may be returned to the olf ce of your alde: man. any City of Chicago Department of Revenue facility, or via mail at PO. Box 803100. Chicago, IL BOtjE0-3100, ATTN, disabled Permitting Section. A $25.00 mainlent-mw fee will be billed to you annually. Should you have qu-= s lions or concerns, please call our permit processing division at 312-744-PARK (7275).
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1 Date ol Birth
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2. Stale Identification dumber
A Applicnnt I nsl Name
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stiiect NAME
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3 Drivers License Number.
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6. Address where signs will be posted
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7. Phone Nuinbcis Homo
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8 Current Permanent Disabled Placard Number feP> \ 'A^X ____
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