APPUClMON^jj^.y , PLEASE READ THE 1 OLIOWING 3& tEFULLY BEIFORE COMP1 ETING THE FO
An application will not hp consider^.' iompl«it<? urtes-.i; Ait i»r«eS uv unw^n»'f i r,tw« pU3n cctnt^t^teil tn'MU;
» a r.hpck f.i ?r»oney orto? lor $70,Ot> made payabh-to w » Ci'y 01 Cntaaijo s s; vww?k; on. payment of in* aiv;ii.->:r.it.».'. Plnase note: The application fee shall be waived 'or arf person holdinp nyai i m.-.v-nt ductal - cetevora pit*. Disability must Pr permanent es evHJerwerJ by a copy e i/'your valfci disflfc sel f po-wrd' and'or cornsof vtthtcft r<H?istra.ksii VJhmHted at 1h-> tine of app|ica»or<.
Proof of residency, in the form of a copy of your uriwr$ ilcenr.«, state identiJfic. [ion. r utility hills are .ferfMicifrsd acjittw time of application.
Compjotrd application «©rm$ may be returned 10: the f,lta> :f your alderman, any. 5*ry c? Chicago-OeparinW:^ c£j*e>tjn;.K /acility. orvia nia'i at P.O. Bo* 803100. Chicago, ft. WV"U0-310H. ATTN:' Disab:sd-'F ASiS&WOwjoitepstaair-
fee be pliiod to you annually. SnrxHri you twve qu r;tior: or concerns. plo:tsc- s»K du; pc/roii proosfsfe^ dlK*fc>iUi! StiS ?.M-PARK :?.?:*.Vi
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14 AHtrrnfttion; I bor*v tfflrm thai tuo stwe iniorwation is ime «rvj c ;rrect. fl the cwyet CM<: Oct ari<n«r\' uv R<sv«r>.in iSflio.-'miw* ir«»'.Bie apptiwiu tws rstseiy ropresenwd ono oi more ot the «Ijim>! cr.j i*«ons. tne aoistifff, rt .slN Che sgujroet:lo■* flnn ot.ro' .«its tlttii WOO bot'rio mty» thin $500. and tNs ttDplicairon sikih be deniod i «lsi undewwud ttwt■ tr"* i in* fldrwrd witty ro hoWy ilKi.t^pAMWwin.^, P»evanui5 6f . ony changes in tho Inlormelion prcvitlod.
Signature
FOR OFFICE USE
□ PI;ACARD/Pl.ATE
□ RESIDENC V
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