Feb 24 2011 6:09PM HP LASERJET FRX
773-523-8440
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Ricbird M. OtJct. Mtyor
Dcfinotai ot Rmooe
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Ciry Picking .AJminmrttor
Bureau of Parking EnibrvtrnerH A» Em C«a$rni Parkway -'nil floor
Chicato. illinoa 60605
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'■ HANDICAPPED PERMIT PARKING
! REMOVAL APPLICATION
I
I FOR SICN REMOVAL RECAROINC PROHIBITED PARKING EXCEPT FOR HANDICAP PERMIT N'LXBER:
(Please princ or type.)
NAME OF HANDICAPPEO INDIVIDUAL:
REMOVAL LOCATION OF HANDICAP PARKING SPACE REQUESTED:
(Please princ or cype current sign location address.) CHICAGO, ILLINOIS (ZIP CODE) fafiMZ (PHONE NUMBER) OQg - g Hl-^SL^l NAME AND ADDRESS OF PERSON CURRENTLY BEING BILLED FOR ANNUAL SIGN MAINTENANCE FEE: _.. ■_________
(Please provide information only if billing information differs.)
ILLINOIS VEHICLE LICENSE NUMBER: _ J_(w or V places)
ILLINOIS HANDICAPPED PLACARD NUMBER: P) F~ "y^^Oilp (Secrecarv of Scat
Handicap Placard!
CERTIFICATION: THE ABOVE JJFQZq&lIOK ISJ£2M£1^T0 THE BEST OF MY KJiOWLEDCJ
(Signature of applicant) FORUARD THIS COMPLETED APPLICATION TO YOUR. ALDERMAN. APPLICANT: DO NOT WRITE BELOW THIS LINE.
ALDERMANIC CERTIFICATION:
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{Dalit)
AJTr-H APPROVAL. THIS APPLICATION' IS 70 8E FORWARDED TO COUNCIL SERVICES. TrS. ALDERMAN. AT THE TIME THE HANDICAP SIGN R£M0VA1. DRT)!N:ANC7. IS IN'TRODl!1'
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