Feb 09 2011 10:49HM HP LASERJET FRX
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City of Chicago
Richard M. Daley, M»yor
Department of Revenue
Bea Reyna-Hickey Director
City Hall. Room 107 121 North LaSalle Strfcel Chicago, Illinois 60602 (312) 747-4747 (IRIS) (312)744-0471 (FAX) (312) 744-2975 fTTY)
DISABLED PERMIT PARKING REMOVAL APPLICATION
FOR SIGN REMOVAL REGARDING PROHIBITED PARKING
EXCEPT FOR DISABLED PERMIT NUMBER. M-^SOD^T_
(Please print or type)
OF DISABLED INDIVIDUAL:
NAME 1
REMOVAL LOCATION OF DISABLED PARKING SPACE REQUESTED:
35oD U). Pierce.
(Please prim 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 IS CORRECT TO THE BEST OF MY KNOWLEDGE:
(Signature of Applicant} FORWARD THIS COMPLETED APPLICATION TO YOUR ALDERMAN.
APPLICANT: nr> NOT WRITE BELOW THIS IINF ALDERMANIC CERTIFICATION: \
(Aldermanic Signature)
(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.