APPLICATION FOR DISABLED PARKING SIGN& PLEASE READ THE FOLLOWING CAREFULLY
74244
P,
BEFORE COMPLETING THE FORM r~*-*~**)
a.-, application will no? be considered complete unless: T" "} ' -■
A« lines of the application have been completed in full. '■ 0 J4*^--'
A chock or money order for $70.00 made payable to the C;ry of Chicago is submitted as payment of the appticn'on .j Please note-' The application fee shall be waived for any person holding a valid, current disaoled veterans p!at«i. y »v Disability "lust he permanent as evidenced by a copy of your valid disabled placard apd'or currni; vehicle n "v ,suited si the f.j, ;-,<:■ o? application: / Proof of residency, in the form of a copy of your drivers license, state identification, or utility bills are submitted at me time of applicatior.
^mplsied application forms may be. returned to: the office of your alderman - any City of Chicago-Department of FtevBRut
facility, or via mail at P.O. Box 803100. Chicago, IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 main* fee will be biilec to yon annually. Should you have questions ot concerns, please call our permit prvvissiriq div&k/r 74-i-PARK {?2?S}.
Dale of Birth
2. State iOentifirsiiion Numfctn
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3. Driveis License' Nurnbtsi
V Arpiir.ant Lasl Name
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First Name
5 Heme Address (primary residence).
^ R'RHirtUWW* L.-!f ! Siid-fT '-iw.\e
fi. Address where signs will be posted
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/. Pnone Number:; ■ Home . Business
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.r«>«t Permanent Ow-soted Placard Numbc
Registered to
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8. Current (license Piarc Nurnboi
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Ratatiansi up to Apptk>8rv \ .
Registered to'
City Stickor'Nc.
,:10.Description.ol Medical Condition and Disability. "fy Q.uJq it 1<$Cl fflA. ^ c?j. j Ai'.omyiivc Parking:
ng: Please note your application may be.deniad rf you hive'afterhative accessible bff^treet poking options
! "1. is mom off-street pacing avnilaDloat you: primary' residence {i.e., garage, car port, driveway, ptc,)?
12. il you answered Yes to aues.tfon. f.f, please describe: . ^Gsracje--■ □ Driveway: . □fCar Port: □■Other:
yes -Ji no
l3.lsvyouf ofi-strefli parking'accessible? )4 □ No. Pfease explain:
ice
14. Affirmation: I hereby affirm that the above information is true and correct. If the City of Chicago Department ol Revenue det«rrft:ocsi thai trio applicant has lalsely represented one or more of the above conditions, Ihe applicant shall be.subject to a iins ol not loss then $100 but no mom lh3n $500, and the application shall be denied. I also understand that it is my responsibility to nolify Ihe Dspartmurii of Revenue of any changes in the information provided.
FOR OFFICE -USE ONLY □ FEE
/^PLACARD/PLATE ^RESIDENCY
FRANK OLIVO
Alderman, 13th Ward
6500 S. Pulaski Road - 60629 Telephone: (773) 581-8000
CITY COUNCIL
CITY OF CHICAGO
COUNCIL CHAMBER
SECOND FLOOR, CITY HALL 121 NORTH LASALLE STREET
TELEPHONE: (312) 744-3076
COMMITTEE MEMBERSHIPS
AVIATION - COMMITTEES RULES and ETHICS FINANCE
LICENSE and CONSUMER PROTECTION BUDGET TRAFFIC CONTROL and SAFETY ZONING
February 24, 2011
Honorable Patrick O'Connor Chairman
Committee on Traffic Control and Safety 121 N. LaSalle Street, Room 300 Chicago, IL 60602
Dear Chairman O'Connor:
I wish to override the following application for handicapped parking signs:
3613 W. 70th Street - #74244
Your assistance with this matter will be greatly appreciated. If you have any questions, please call Shari Knight at (773) 581-8000.
With kindest personal regards, I remain
Sincerely,
Frank J. Olivo Alderman, 13th Ward