APPLICATION FOR: DISABLED PARKING SIGNS PLEASE rIeAD THE FOLLOW
BEFORE COMPLETING THE FORM S~
72136-
An application will not be considered complete! unless: AH lines ol the applicatiort'have been-c6mpk?1ed in lull; -A^chcck uvriiortey order for $70.00 rnsde,payabie to-'tne pity .of Chicago.is. submitted as payment pf thu .^pfcc^icm ;oe /Please note: The application lee.sr:;.tl.l be,waived for any person holding a valid.-current-disabled .veterans yia'a .
' Disability must be permanent as evidenced by a copy of your valid disabled placard and/or current v$Kc~ rejjistfalion''
submitied'ai the time oi application; ¦W- Proof of residency, in the form of a copy of your drivers license, date identification, or utility biils are submitted at the time cf application.
Completed application forms may be returned to- the.officeo? your 'aide.! man. any City of Chicago Department est Revenue •* facility, or via mairat P.O. Box 803100. Chicago. IL 60680-3100, ATTN: Disabled Permitting Section. A $25.00 ma-mnmoet fee will bri billed to you annually. Should you have questions or concerns, pieoise call our'permit proc'.ssVv';; diyifiC'i s\ 312-
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Dnv^is tacsiise Number
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¦*i Appiicant Last K'amo . . Il Ml |
744-PARK (7275).
L. Oa'O Oi Biflf: ' i
i'j<%£ Ki;:'iu!>i;a::Or) dumber
ft li/.ISJ j \U
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e in
First Nrimt?
Vi-I ii
(5. Horn?. Address {primary residence)
6i Oj 3 0 Is ' Ik je jfr K P* 1" j
.¦'S-:' Address where sts«s will be posted Phone Nu-T:ticfi'
Fr-' l:;
¦Hoine
7i7 ;3 —.7 r6- iV"T* '6 if" tl
Business
8. Current Petrnanent Disabled-Placard Number Registered to
6 A 2 1353_________Posij Ku^dork.
¦9. Current License Plate Number
Registered to
Ci:y Silckor No.
GUN S
Retationshit: to Applicant
Retat:ohstvp to Applicant
£10.Description of Medical Condition and Disability i
Kn e c_Pa> <7 -f<-s?m_____^^r.£.rZ„^^J2i^;.',^
Alternative Parking: Please note your applicat...
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