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APPLICATION FOR DISABLED PARKING SIGNS PLEASE READ THE FOLLOWING CAREFULLY BEFORE COMPLETING THE FORM
An application will not be considered complete unless: t~~ ^-r*"" ~~^V^ ^
• All lines of the application have been completed in full; (^^^-^J/^Cl^^)/ »•—1A check or money order for S703)0 made payable to the City of Chicago is submitted as payment oTihe application tee; Pfease note: The application fee shall be waived for any person holding a valid, current disabled veterans plate Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current vehicle registration submitted at the time of application; <-rp - I? I.
f/Proof of residency, in the form of a copy of your drivers license, state iTrentificafio^, or utility Dills are^bmrae/fjanHfe V time of application. j I ^y//^^
Completed application forms may be returned to: the office of your alderman, any City of Chicago Department of Revenue facility, or via mail at P.O. Box 803100. Chicago. IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 maintenance fee will be billed to you annually. Should you have questions or concerns, please call our permit processing division at 312-744-PARK (7275).
1. Date of Birth
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2. State Identification Number
3. Drivers License Number
4. Applicant Last Name
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5. Home Address (primary residence)
STREET NUMBER DIR. STREET NAME
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6. Address where signs will be posted
STREET NUMBER OIR. STREET NAME
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warp number
7. Phone Numbers
Home
Business
8. Current Permanent Disabled Placard Number
____, Registered to
Relationship to Applicant
9. Current License Plate Number
Registered to
City Sticker No.
Relationship to Applicant
10. Description of Medical Condition and Disability
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Alternative Parking: Pfease note your application may be denied if you have alternative accessible off-street parking options.
11. Is there ...
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