A-> app.!catto»:
APPLICATION FOR DISABLED PARKING SiGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING-THE FORM
no? oe considered conirjfcJte'i/rifefjs:
Ail imes ol the application have been completed in full:'?5^''/^
74237 '
A check c! money eider for S70 00; made payable to.tfe'Gily of Chicago 15. su£n>ttert as p?ytntMit of t:v
j?iease noie: The application fee shall be'waived for any person-holding a valid, cufranrdisaofed veterans piale. */;/'f Di----.itiihiv must be permanent as evidenced fcy a copy of your w»Hcl disabled pi -.-art -id/o.- rurr.^t yp'm~ v-ytetritit-r T' suonrtitted at iha time? of application;- ^V-. - vx^-'b AciC' rv
v pio* i swhtency, ihe- lorrn uf a c:.ovci ycur diivars ^cense, stato idenliriivUiO?* ¦:' s.a^; • hilt::, arts i^rn-^sc?
Urn*:- of application. ' i j ' 11 ^
Completed application fcrrns may be returned to: hvj nflica of your alderman, any Cily ot Chicago Daoartmenr %>. Raw* tus-Eerily, tM v.'ii'ma'! •*, P.C Bcv *03100. Chi:v*gc. IL OCSSO-SlOO. ATTN: Disfehifd P.?»n*.....-jf?cu;o'-., A •. .iinl'-iarr-
fee win o
nQ oii- -'.".un : 3t£ v-,.!.pAaK ( r::?5!
S 2 Stats Ider-«ificaii3» Number j 3. Drive-? Uovse f^sbo
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5. Horru* Address {primary residence)
l1 i.JSi2l:XL...[!-rl J^_.;:„.ii:u.JL!.^.^i
i 6. A{tdr«*s& wi^ic signs pa posted
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i Business
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8. Current Permanent Otsatisad Placard Number
. Registered to
5 Currc''! License Plate Number
Rogistfiffiri to
i City Srirttef
Reiationshlo to Aoplicsrvt
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IC.O^ -'-.fj'iori o» Medico' Condition and Ohao:liN*
Alternative Parking. Pidase note your applicahC!1 may be du^iod n you havo alternative Bccc;.»ibk» o!f-street par King Oj:: ms
t'.fe the:e off••;ir«et paring available at your primary restdcr-ce ~i YES NO I...
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